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Immediate versus delayed treatment for supracondylar fractures

One of the biggest controversies in the management of pediatric elbow fractures has to do with the timing of operative intervention for supracondylar humerus fractures.

In 2001, in the American edition of the Journal of Bone and Joint Surgery (March Issue, 83-A, page 323-7), Dr. Alan Crawford published a very interesting study entitled “The effect of surgical timing on the preoperative complications of treatment of supracondylar humerus fractures in children”.

This study was designed to evaluate whether or not there was a higher rate of complications associated with delayed treatment after a supracondylar elbow fractures. The authors defined early treatment as surgical reduction that occurred within 8 hours, and delayed treatment as surgery that occurred more than eight hours after the injury.

Fifty two children had early surgery (within 8 hours) and 146 children had late surgical treatment (after 8 hours). The study found that there was no difference between the two groups, which established for the first time that pediatric elbow fractures did not necessarily need to be treated in the middle of the night. This is an important finding, because many other studies have shown that the overall rates of operative complications increase when surgery is performed “after hours” or in the middle of the night, and often, it is better to wait till the morning when the operating room is in the normal swing of activity.

This was a really important study because prior to this study, the orthopedic community used to believe that there was a principle that you should never “let the sun set on a supracondylar fracture of the humerus”, which obligated the vast majority of cases to be treated in the middle of the night.  With this study, there was at least some scientific basis to waiting throughout the night and treating the fracture in the morning.  However, this treatment option is not without its risks.  The child has to be under the care of someone who is cognizant of the risks of a vascular injury in the setting of a supracondylar elbow fracture, and in one of our case law examples, we present the narrative of a child who ended up developing a catastrophic complication as the result of a delay in treatment.  For full details of this narrative, read the entire story here.

The full abstract for the study on delayed versus immediate treatment of supracondylar humerus fractures is as follows:

J Bone Joint Surg Am. 2001 Mar;83-A(3):323-7.

The effect of surgical timing on the perioperative complications of treatment of supracondylar humeral fractures in children.

Mehlman CT, Strub WM, Roy DR, Wall EJ, Crawford AH.

Source

Division of Pediatric Orthopaedic Surgery, Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Ohio 45229-3039, USA.

Abstract

BACKGROUND: The purpose of this study was to evaluate the perioperative complication rates associated with early surgical treatment (eight hours or less following injury) and delayed surgical treatment (more than eight hours following injury) of displaced supracondylar humeral fractures in children.

METHODS: Fifty-two patients had early surgical treatment and 146 patients had delayed surgical treatment of a displaced supracondylar humeral fracture. The perioperative complication rates of the two groups were compared with the use of bivariate and multivariate statistical methods.

RESULTS: There was no significant difference between the two groups with respect to the need for conversion to formal open reduction and internal fixation (p = 0.56), pin-track infection (p = 0.12), or iatrogenic nerve injury (p = 0.72). No compartment syndromes occurred in either group. Power analysis revealed that our study had an 86% power to detect a 20% difference between the two groups if one existed.

CONCLUSIONS: We were unable to identify any significant difference, with regard to perioperative complication rates, between early and delayed treatment of displaced supracondylar humeral fractures. Within the parameters outlined in our study, we think that the timing of surgical intervention can be either early or delayed as deemed appropriate by the surgeon.

2 comments

  1. Randy Travis says:

    This website definitely seems more legitimate than yahoo answers, but its credibility would be greatly enhanced if proper grammar and vocabulary were employed. Avoid using “an” before anything but vowels. For example, on the FAQ page, there were various errors that said things like, “an those” or “it this point.” You’re welcome.

    1. admin says:

      Thanks for the proofreading. I’ve run through the FAQs and I’ll try to work my way through the rest of the site as time permits.

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