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Clinical and radiographic outcomes of supracondylar humerus fractures treated surgically by pediatric and non-pediatric orthopedic surgeons.

Dodds SD, Grey MA, Bohl DD, Mahoney EM, DeLuca PA - J Child Orthop (2015)

Bottom Line: The rate of inadequate fracture fixation was higher for patients treated by NPOs (43.5 %) than for patients treated by POs (14.7 %; p = 0.030), but rates of clinical complications, malreduction, and postoperative loss of reduction did not differ.Treatment with open reduction was more common for patients treated by NPOs (33.3 %) than for patients treated by POs (3.5 %; p < 0.001).While patients treated by POs differed from patients treated by NPOs with respect to several intermediate outcomes, including having a lower rate of open reduction and a lower rate of inadequate fracture fixation, there were no differences between POs and NPOs in the rates of the more meaningful and definitive outcomes, including clinical complications, malreduction, and postoperative loss of reduction.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 800 Howard Ave., New Haven, CT, 06519, USA, seth.dodds@yale.edu.

ABSTRACT

Purpose: This study compares clinical and radiographic outcomes of operatively managed pediatric supracondylar humerus fractures between patients treated by pediatric orthopedists (POs) and patients treated by non-pediatric orthopedists (NPOs).

Patients and methods: A retrospective cohort study of pediatric patients with surgically managed supracondylar humerus fractures was conducted. For clinical outcomes analyses, 3 months of clinical follow-up were required, resulting in a sample size of 90 patients (33 treated by NPOs, 57 by POs). For radiographic outcomes analyses, 3 months of both clinical and radiographic follow-up were required, resulting in a sample size of 57 patients (23 treated by NPOs, 34 by POs).

Results: The rate of inadequate fracture fixation was higher for patients treated by NPOs (43.5 %) than for patients treated by POs (14.7 %; p = 0.030), but rates of clinical complications, malreduction, and postoperative loss of reduction did not differ. Treatment with open reduction was more common for patients treated by NPOs (33.3 %) than for patients treated by POs (3.5 %; p < 0.001). Total operating room time was longer for patients treated by NPOs (110.9 min) than for patients treated by POs (82.9 min; p < 0.001).

Conclusions: While patients treated by POs differed from patients treated by NPOs with respect to several intermediate outcomes, including having a lower rate of open reduction and a lower rate of inadequate fracture fixation, there were no differences between POs and NPOs in the rates of the more meaningful and definitive outcomes, including clinical complications, malreduction, and postoperative loss of reduction.

No MeSH data available.


Related in: MedlinePlus

Adequate fracture fixation and appropriate reduction. a AP with pins. b Lateral with pins. c AP after healing. d Lateral after healing
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Fig1: Adequate fracture fixation and appropriate reduction. a AP with pins. b Lateral with pins. c AP after healing. d Lateral after healing

Mentions: Radiographic outcomes are compared between patients treated by NPOs and patients treated by POs in Table 6. Of note, unlike for all previously listed results, the following analysis was conducted among the restricted cohort instead of the full cohort. The restricted cohort required both a minimum of 3 months of radiographic follow-up and a minimum of 3 months of clinical follow-up. There were no differences in radiographic outcomes between patients treated by NPOs and patients treated by POs, with one exception: patients treated by NPOs were more likely to have inadequate fracture fixation (43.5 %) than patients treated by POs (14.7 %; p = 0.030). Examples of adequate and inadequate fracture fixation are shown in Figs. 1 and 2, respectively. The case with adequate fixation (Fig. 1) was appropriately reduced and had no postoperative loss of reduction. The case with inadequate fixation (Fig. 2) had pins with minimal separation between their entrance sites. It was also malreduced with the anterior humeral line anterior to the capitellum.Table 6


Clinical and radiographic outcomes of supracondylar humerus fractures treated surgically by pediatric and non-pediatric orthopedic surgeons.

Dodds SD, Grey MA, Bohl DD, Mahoney EM, DeLuca PA - J Child Orthop (2015)

Adequate fracture fixation and appropriate reduction. a AP with pins. b Lateral with pins. c AP after healing. d Lateral after healing
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4340853&req=5

Fig1: Adequate fracture fixation and appropriate reduction. a AP with pins. b Lateral with pins. c AP after healing. d Lateral after healing
Mentions: Radiographic outcomes are compared between patients treated by NPOs and patients treated by POs in Table 6. Of note, unlike for all previously listed results, the following analysis was conducted among the restricted cohort instead of the full cohort. The restricted cohort required both a minimum of 3 months of radiographic follow-up and a minimum of 3 months of clinical follow-up. There were no differences in radiographic outcomes between patients treated by NPOs and patients treated by POs, with one exception: patients treated by NPOs were more likely to have inadequate fracture fixation (43.5 %) than patients treated by POs (14.7 %; p = 0.030). Examples of adequate and inadequate fracture fixation are shown in Figs. 1 and 2, respectively. The case with adequate fixation (Fig. 1) was appropriately reduced and had no postoperative loss of reduction. The case with inadequate fixation (Fig. 2) had pins with minimal separation between their entrance sites. It was also malreduced with the anterior humeral line anterior to the capitellum.Table 6

Bottom Line: The rate of inadequate fracture fixation was higher for patients treated by NPOs (43.5 %) than for patients treated by POs (14.7 %; p = 0.030), but rates of clinical complications, malreduction, and postoperative loss of reduction did not differ.Treatment with open reduction was more common for patients treated by NPOs (33.3 %) than for patients treated by POs (3.5 %; p < 0.001).While patients treated by POs differed from patients treated by NPOs with respect to several intermediate outcomes, including having a lower rate of open reduction and a lower rate of inadequate fracture fixation, there were no differences between POs and NPOs in the rates of the more meaningful and definitive outcomes, including clinical complications, malreduction, and postoperative loss of reduction.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 800 Howard Ave., New Haven, CT, 06519, USA, seth.dodds@yale.edu.

ABSTRACT

Purpose: This study compares clinical and radiographic outcomes of operatively managed pediatric supracondylar humerus fractures between patients treated by pediatric orthopedists (POs) and patients treated by non-pediatric orthopedists (NPOs).

Patients and methods: A retrospective cohort study of pediatric patients with surgically managed supracondylar humerus fractures was conducted. For clinical outcomes analyses, 3 months of clinical follow-up were required, resulting in a sample size of 90 patients (33 treated by NPOs, 57 by POs). For radiographic outcomes analyses, 3 months of both clinical and radiographic follow-up were required, resulting in a sample size of 57 patients (23 treated by NPOs, 34 by POs).

Results: The rate of inadequate fracture fixation was higher for patients treated by NPOs (43.5 %) than for patients treated by POs (14.7 %; p = 0.030), but rates of clinical complications, malreduction, and postoperative loss of reduction did not differ. Treatment with open reduction was more common for patients treated by NPOs (33.3 %) than for patients treated by POs (3.5 %; p < 0.001). Total operating room time was longer for patients treated by NPOs (110.9 min) than for patients treated by POs (82.9 min; p < 0.001).

Conclusions: While patients treated by POs differed from patients treated by NPOs with respect to several intermediate outcomes, including having a lower rate of open reduction and a lower rate of inadequate fracture fixation, there were no differences between POs and NPOs in the rates of the more meaningful and definitive outcomes, including clinical complications, malreduction, and postoperative loss of reduction.

No MeSH data available.


Related in: MedlinePlus