Closed reduction and stabilization of supracondylar fractures of the humerus in children: the crucial factor of surgical experience

• Published in: Journal of pediatric orthopaedics. B Vol. 19; no. 4; p. 298
• Main Authors: Padman, Manoj, Warwick, Andrea M, Fernandes, James A, Flowers, Mark J, Davies, Anthony G, Bell, Michael J
• Format: Journal Article
• Language: English
• Published: United States 01.07.2010
• Subjects: Adolescent; Child; Child, Preschool; Clinical Competence; Female; Fracture Fixation - methods; General Surgery; Humans; Humeral Fractures - therapy; Immobilization - methods; Infant; Male; Treatment Outcome
• ISSN: 1473-5865
• DOI: 10.1097/BPB.0b013e328333ab18

We reviewed the outcome following operative management of displaced (Gartland II and III) supracondylar fractures of the humerus in children over a 2-year period and tried to correlate the outcome with various factors including experience of the treating surgeon. Of the 71 children who formed the study group, 62 (87.3%) had a good outcome irrespective of the treatment modality. Closed reduction followed by plaster immobilization or percutaneous pinning resulted in a better outcome than open reduction. There was a direct involvement of the consultant in the primary management of these injuries in 17 cases (24%), none of which had a poor outcome. Of the 54 cases in whom the primary management was carried out independently by trainees without any consultant supervision, nine patients (17%) developed complications or needed reoperations. The proportion of unsatisfactory outcomes increased to 20.3% when failure to achieve a satisfactory reduction by closed means was also considered as a perioperative complication. There is a learning curve associated with percutaneous pinning after closed reduction and experience of the surgeon seems to be one of the factors that have an influence on the outcome.