Epidemiologic investigation of pediatric distal humerus fractures: An American insurance claims database study

BACKGROUND Distal humerus elbow fractures are one of the most common traumatic fractures seen in pediatric patients and present as three main types:Supracondylar(SC),lateral condyle(LC),and medial epicondyle(ME)fractures.AIM To evaluate the epidemiology of pediatric distal humerus fractures(SC,LC,and ME)from an American insurance claims database.METHODS A retrospective review was performed on patients 17 years and younger with the ICD 9 and 10 codes for SC,LC and ME fractures based on the IBM Truven MarketScan®Commercial and IBM Truven MarketScan Medicare Supplemental databases.Patients from 2015 to 2020 were queried for treatments,patient age,sex,length of hospitalization,and comorbidities.RESULTS A total of 1133 SC,154 LC,and 124 ME fractures were identified.SC fractures had the highest percentage of operation at 83%,followed by LC(78%)and ME fractures(41%).Male patients were,on average,older than female patients for both SC and ME fractures.CONCLUSION In the insurance claims databases used,SC fractures were the most reported,followed by LC fractures,and finally ME fractures.Age was identified to be a factor for how a pediatric distal humerus fractures,with patients with SC and LC fractures being younger than those with ME fractures.The peak age per injury per sex was similar to reported historic central tendencies,despite reported trends for younger physiologic development.

Time of surgery and surgeon level in supracondylar humerus fractures in pediatric patients:A retrospective study

BACKGROUND Supracondylar humerus fractures account for more than 60%of all elbow fractures and about 1/5 of all pediatric fractures.Unfortunately,these fractures can be associated with risk of complications including neurovascular injuries,malunions and limb deformities.Controversy exists regarding the effect of time of surgical intervention and/or level of surgeon performing the surgery on outcome of these fractures.AIM To determine whether time of surgical intervention and/or surgeon level influence the outcomes of surgically managed pediatric supracondylar humerus fractures.METHODS We retrospectively studied 155 pediatric patients presenting with a supracondylar humerus fracture in a level 1 trauma center from January 2006 to December 2019.The data extracted included demographic data,fracture characteristics,surgical data,and follow-up outcomes.The collected data was analyzed and P values of<0.05 were considered statistically significant.RESULTS Of the cohort,11%of patients had documented post-operative complications,of which the majority occurred in surgeries performed after day time working hours and in fractures requiring open reduction.While the lowest complication rate was found in surgeries performed by pediatric orthopaedic surgeons,this did not reach statistical significance.CONCLUSION In pediatric patients undergoing surgery for supracondylar fractures,we found a higher complication rate when surgeries were not performed during working hours.Surgeon level and training had no significant effect on the risk of post-operative complications.

Blount Method in the Management of Supracondylar Fractures of the Humerus in Children

Supracondylar fractures of the humerus are the most common traumatic elbow injury in children. Several techniques are described in their support. Blount’s method is one of the widely used orthopedic means. The objective of our study was to evaluate the results of supracondylar fractures of the humerus treated by this method in our department. This was a descriptive, longitudinal study with the prospective collection over a period of 12 months from May 2018 to April 2019. It focused on children aged 0 to 15 years treated in the Orthopedic Traumatology Department of the CHU of Kati for a supracondylar fracture of the humerus in extension. A minimum follow-up period of 6 months was necessary for inclusion. 12 patients were collected. The sociodemographic, anatomopathologic, therapeutic and evolutionary aspects were studied. The results were evaluated according to Flynn’s criteria. The male sex was predominant with a ratio of 2. The average age was 5.5 years. The average admission time was 12.5 hours. Domestic accidents were the main etiology (66.66%) and Type II fracture was the most frequent with 58.33%. The duration of immobilization was 42 days for 11 patients. Complications were 1 case of secondary displacement and 1 case of 12&#730 flexion deficit. The average Baumann angle was 72&#730. The result was satisfactory for all our patients. Supracondylar fractures of the humerus are common in children, especially boys. The method of Blount when it is well carried out by respecting the indications gives good results.

Evaluation of Surgical Treatment of Distal Humeral Fractures in Adults

Introduction: Fractures of the distal end of the humerus are becoming increasingly frequent in young subjects because of the increase in road traffic accidents, and in elderly subjects because of osteoporosis related to aging populations. Materials and Methods: It was a prospective, monocentric study from January 2018 to December 2020 involving 14 patients who received and were treated surgically for distal humeral fractures and followed up. Results: We collected 14 patients, including 11 men (78.57%) and 3 women (21.43%), with a sex ratio of 3.7. The mean age was 36.41 years. The circumstances of onset were dominated by road traffic accidents, with 12 cases (85.71%). The dominant side was right-handed, with 11 cases (78.57%). Standard elbow radiography revealed 8 cases of type A fractures (57.14%), 4 cases of type B and 2 cases of type C fractures of the AO. We performed Lecestre plate osteosynthesis in 12 patients and external fixator in 2 others, using the trans-olecranial and transtricipital approaches. Elbow stiffness was the most frequent complication, with 6 cases (42.86%). After six months’ follow-up, our results were excellent and good in 78.57% of cases (MEPS). Conclusion: Surgical treatment with posterior approaches enabled us to achieve restitution of the articular surfaces, solid restraint and early mobilization of the elbow with satisfactory functional results.

Modified Closed Reduction and Percutaneous Kirschner Wires Internal Fixation for Treatment of Supracondylar Humerus Fractures in Children

Objective Supracondylar humerus fractures are the most frequent fractures of the paediatric elbow.The present study introduced a modified surgical procedure for treatment of supracondylar humerus fractures in children.Methods From February 2015 to August 2019,73 patients with Gartland’s type II and III supracondylar fractures were treated with this modified method.Totally,68 of all patients were followed up for 3–12 months(mean 8.25 months).The evaluation results included fracture nonunion,ulnar nerve injury,pin track infection,carrying angle and elbow joint Flynn score.Results The results showed that bone union was observed in all children,one case had an iatrogenic ulnar nerve injury,and the symptoms were completely relieved in 4 months after removing of the medial-side pin.All children had no cubitus varus deformity and no pin track infection,and the rate of satisfactory results according to Flynn’s criteria score was 100%.Conclusion The modified closed reduction and Kirschner wires internal fixation could effectively reduce the rate of open reduction,the risk of iatrogenic ulnar nerve injury,and the incidence of cubitus varus deformity in treatment of supracondylar humerus fractures in children.

CLOSED REDUCTION AND PERCUTANEOUS K-WIRES FIXATION OF DISPLACED SUPRACONDYLAR HUMERUS FRACTURES IN CHILDREN

To observe the effects of closed reduction and percutaneous K wires fixation of displacd supracondylar humerus fracture in children MethodsRetrospective review of fourteen patients who sustained displaced supracondylar fracture of distal humerus treated by closed reduction and percutaneous K wires fixation Results. All patients’ K wires were removed at 4 weeks post operation Their elbow function regained at 8 weeks The average period of followed up was 10 month (varies from 6 to 18 month), all fractures healed very well without any permanent complications Two transient nerves palsy,ulnar and radial nerve each, recovered completely at 12 weeks and 16 weeks post operation respectively Conclusion. Closed reduction and percutaneous K wires fixation is a safe and efficient treatment for displaced humerus surpracondylar fracture in children

Clinical significance of Baumann's angle in the percutaneous pinning fixation for supracondylar fractures of the humerus in children

To evaluate the clinical significance of Baumann’s angle in the closed reduction and percutaneous pinning fixation for supracondylar fractures of the humerus in children.Methods There were 97 children (male 59,female 38,mean age of 6.8 years) with displaced supracondylar fracrtures of the humerus were treated in this hospital.Under fluoroscopy guidance,three-dimensional displacement of fractures was corrected by closed reduction.The percutaneous Kirschner wire pinning was applied only if the radiographs demonstrated that Baumann’s angle was less than 4 degree compared to that on the normal side.All of them were followed up for 34.5 months (range,12 to 48 months).Results There was one case with ulnar nerve palsy associated with the pinning.There were no Volkmann’s contracture in this group.X-ray examinations revealed an average 73.7 degrees of Baumann angle on the injured and 72.8 on uninjured side.An average 7.6 degrees of the carrying angle on the injured and 9.7 on uninjured side were also demonstrated by radiography.Five patients developed slight cubitus varus deformity.The result according to Flynn criteria were excellent in 85 patients (87.6%),good in 12 patients (12.4%).Conclusion The satisfactory results can be gained in children with displaced supracondylar fractures of the humerus by restoration of the normal Baumann angle and percutaneous pinning fixation.18 refs,2 figs.

The Effect of Weather Conditions on Pediatric Supracondylar Humerus Fractures

Background: Environmental conditions are effective on childhood supracondylar humerus fractures. In this study, we evaluated the relationship between weather conditions and these fractures. Materials and Methods: We started this study following the approval of a non-interventional research ethics committee. Patients (<16 years) who applied to the hospital between January 2013 and July 2018 with supracondylar humerus fractures were included in the study. The hospital’s PROBEL system was used to diagnose (International Classification of the Diseases, ICD, S42.4) radiological images and patient information. Information on the weather conditions in the day and time period, in which supracondylar humerus fracture occurred, was obtained from TR (Turkey) Ministry of Agriculture and Forestry General Directorate of Meteorology. The relationship between supracondylar fracture and daily weather conditions (wind, air temperature, cloudiness, and season) was analyzed. Results: Most of the patients (n = 76, 40.6%, p < 0.05) were fractures occurring under cloudless weather conditions. Fractures were concentrated with a second frequency in cloudy weather over 60%, except for cloudless weather conditions (n = 51, 27.3%, p < 0.05). In the summer months when the air temperature was high, the number of fractures was higher (n = 62, 33.2%, p < 0.05) and less in the winter months (n = 24, 12.8%, p < 0.05). In hot weather conditions where the daily average temperature was above 20°C, supracondylar humerus fractures were observed more (n = 101, 54%) and less than 10°C (n = 43, 23%, p < 0.05). Increased incidence of fractures was observed in the presence of wind (n = 4, 2.1%, p < 0.05). Conclusion: Supracondylar humerus fractures are common in children. Environmental conditions (temperature, wind, and season) can be effective in the occurrence of these fractures.

Percutaneous fixation of neonatal humeral physeal fracture: A case report and review of the literature

BACKGROUND Neonatal distal humeral physeal fractures are rare and difficult to diagnose.Thus,missed diagnoses and delayed healing are possible.Few studies have reported surgical treatment,because a callus may develop at the fracture site 5 d after the fracture,resulting in difficult reduction,and reduction of the limb may cause further physeal injury.Other surgical challenges include the provision of adequate anesthesia and complexity of the operation.However,without appropriate reduction and fixation,a varus elbow deformity may develop.Manual reduction and percutaneous pin fixation are ideal treatment options.CASE SUMMARY A 4-day-old neonate with left elbow pain accompanied by limited movement for 4 d was admitted,and diagnosed with delayed physeal fracture of the distal humerus based on physical examination,ultrasonography,and magnetic resonance imaging.The patient was treated by manual reduction combined with percutaneous pin fixation under arthrography.Postoperatively,the reduction was successful.The upper limbs could have been lifted and the fingers could have been moved freely on the second day after the operation.CONCLUSION The techniques of manual reduction and percutaneous pin fixation,to treat neonatal distal humeral physeal fractures,are safe and reliable.

Treatment of femur supracondylar fracture with retrograde interlocking intramedullary nails in elderly patients

Objective： To report 32 cases of femur supracondylar fracture treated with retrograde interlocking intramedullary nails in elderly patients. Methods： According to the AO classification, all of 32 cases were classified as extra-articular type A. 32 cases were treated with interlocking intramedullary nail by closed insertion from intercondylar fossa of the knee. All cases accepted CPM exercise as early as possible after operation. Results： Following up 5 to 15 months, all fractures united within an average duration of 5.3 months （4-7 months）. According to the Shelbourne scale, the excellent rate of the knee function was 86.3%. Conclusion： Retrograde interlocking intramedullary nail is useful alternative implant for the treatment of osteoporotic supracondylar fracture of femur, particularly of the type A fracture in the elderly population. Its merits include stable fixation, high rate of fracture union and few complications.

Pediatric Supracondylar Humerus Fractures: Are Medial Pins Indicated?

Background: Pediatric supracondylar humerus fractures are the most common elbow fractures in children. Operative management includes closed reduction and placement of 2 to 3 laterally based pins. Occasionally, a medial pin is used to create a crossed fixation pattern, despite risk of nearly 10% iatrogenic ulnar nerve injury. The objective of this study was to assess the trends and outcomes in the operative management of pediatric supracondylar humerus fractures at a level one academic trauma center. Materials & Methods: A retrospective review was performed on all children sustaining a Gartland type II or III supracondylar humerus fractures treated by closed or open reduction and percutaneous pinning in 2006-2008 and 2009-2011 at a level one academic trauma center by two of the authors (JTR, LMT). Pin placement patterns were evaluated and compared based on year performed. Outcomes measured were rates of ulnar nerve symptoms, non-union, re-operation, and varus malalignment. Data analysis was performed using a Fisher exact test on STATA software. Results: A total of 49 patients met inclusion criteria. Of 22 patients treated in 2006-2008, 5 (23%) were type II and 17 (77%) were type III. From 2009-2011, 16 (59%) were type II and 11 (41%) were type III. Comparison of pinning pattern in type II fractures between 2006-2008 and 2009-2011 did not indicate statistical significance (p = 0.429). Comparison of pinning pattern in type III fractures during the same time period did show that there was a statistically significant decrease (p = 0.010) in the number of cross pin fixations. There were no ulnar nerve injuries, non-unions, re-operations, or varus malalignment in any patient on final follow-up. Conclusion: This study shows that there has been a significant decrease in cross pin fixation for pediatric type III supracondylar humerus fractures with equivalent clinical outcomes at a Level I trauma center. Furthermore, performing lateral pinning for type III fractures has eliminated the risk of iatrogenic ulnar nerve injury. Level of Evidence: Level III—Retrospective cohort study.

Fragility of statistically significant findings from randomized clinical trials of surgical treatment of humeral shaft fractures:A systematic review

BACKGROUND Despite recent meta-analyses of randomized controlled trials(RCTs),there remains no consensus regarding the preferred surgical treatment for humeral shaft fractures.The fragility index(FI)is an emerging tool used to evaluate the robustness of RCTs by quantifying the number of participants in a study group that would need to switch outcomes in order to reverse the study conclusions.AIM To investigate the fragility index of randomized control trials assessing outcomes of operative fixation in proximal humerus fractures.METHODS We completed a systematic review of RCTs evaluating the surgical treatment of humeral shaft fractures.Inclusion criteria included:articles published in English;patients randomized and allotted in 1:1 ratio to 2 parallel arms;and dichotomous outcome variables.The FI was calculated for total complications,each complication individually,and secondary surgeries using the Fisher exact test,as previously published.RESULTS Fifteen RCTs were included in the analysis comparing open reduction plate osteosynthesis with dynamic compression plate or locking compression plate,intramedullary nail,and minimally invasive plate osteosynthesis.The median FI was 0 for all parameters analyzed.Regarding individual outcomes,the FI was 0 for 81/91(89%)of outcomes.The FI exceeded the number lost to follow up in only 2/91(2%)outcomes.CONCLUSION The FI shows that data from RCTs regarding operative treatment of humeral shaft fractures are fragile and does not demonstrate superiority of any particular surgical technique.

Plate vs reverse shoulder arthroplasty for proximal humeral fractures:The psychological health influence the choice of device?

BACKGROUND Proximal humeral fractures represent the third most common observed osteoporotic fracture;the treatment in three and four-part proximal humeral fractures in patients over 65 years is still controversial.Among the treatments described in literature,open reduction and internal fixation(O.R.I.F)and reverse shoulder arthroplasty(RSA)are gaining an increasing popularity.AIM To investigate the correct treatment for three and four-part proximal humeral fractures according to psychological aspects.METHODS It was conducted a prospective study with a series of 63 patients treated with O.R.I.F.(group A)and with RSA(group B)for three and four-part proximal humeral fractures according to Neer classification system.A conservative treatment group,as control,was finally introduced.One independent observer performed clinical and a psychological evaluation at one(T0),six(T1)and twelve months(T2)postoperatively.The Constant’s score and The Disabilities of the Arm,Shoulder and Hand(DASH score)were used for clinical evaluation,while General Anxiety Disorder-7(GAD-7)and Caregiver Strain Scale(CSS)were used for psychological evaluation.RESULTS At one month follow up in group A the mean values were DASH score 50.8,Constant score 36.1,GAD-7 score 5.4,CSS 5.0.For the group B,the average values at T0 were:DASH score 54.6,Constant score 32.0;GAD-7 score 6.4,CSS 6.2.At six months in group A the average values were DASH score 42.1,Constant score 47.3,GAD-7 score 4.3,CSS 3.9.For the group B,the average values at T1 were:DASH score 39.1,Constant score 43.2,GAD-7 score 5.7,CSS 5.5.At twelve months in the group A,the mean values were DASH score 32.8,Constant score 60.0,GAD-7 score 3.2,CSS 3.1.For the group B shown these mean values:DASH score 33.6,Constant score 52.9,GAD-7 score 4.3,CSS 4.5.We demonstrated a better clinical and psychological outcome at T2 in the group treated with osteosynthesis compared to the group treated with arthroplasty(Constant P=0.049,GAD-7 P=0.012 and CSS P=0.005).A better clinical and psychological outcome emerged in control group at T2 comparing with surgical group(DASH score P=0.014,Constant score P<0.001,GAD-7 P=0.002 and CSS P=0.001).CONCLUSION Both open osteosynthesis and reverse shoulder arthroplasty are valid treatments for proximal humeral fractures.According to the best osteosynthesis results the authors suggested to perform a psychological analysis for each patient in order to choose the appropriate treatment.

Effectiveness of an early operating room start time in managing pediatric trauma

BACKGROUND The timing of operative treatment for pediatric supracondylar humerus fractures(SCHF)and femoral shaft fractures(FSF)remains controversial.Many fractures previously considered to be surgical emergencies,such as SCHF and open fractures,are now commonly being treated the following day.When presented with an urgent fracture overnight needing operative treatment,the on-call surgeon must choose whether to mobilize resources for a late-night case or to add the case to an elective schedule of the following day.AIM To describe the effect of a program allowing an early operating room(OR)start for uncomplicated trauma prior to an elective day of surgery to decrease wait times for surgery for urgent fractures admitted overnight.METHODS Starting in October 2017,patients were eligible for the early slot in the OR at the discretion of the surgeon if they were admitted after 21:00 the previous night and before 05:00.We compared demographics and timing of treatment of SCHF and FSF treated one year before and after implementation as well as the survey responses from the surgical team.RESULTS Of the 44 SCHF meeting inclusion criteria,16 received treatment before imple mentation while 28 were treated after.After implementation,the mean wait time for surgery decreased by 4.8 h or 35.4%(13.4 h vs 8.7 h;P=0.001).There were no significant differences in the operative duration,time in the post anesthesia care unit,and wait time for discharge.Survey results demonstrated decreased popularity of the program among nurses and anesthesiologists relative to surgeons.Whereas 57%of the surgeons believed that the program was effective,only 9%of anesthesiologists and 16%of nurses agreed.The program was ultimately discontinued given the dissatisfaction.CONCLUSION Our findings demonstrate significantly reduced wait times for surgery for uncomplicated SCHF presenting overnight while discussing the importance of shared decision-making with the stakeholders.Although the program produced promising results,it also created new conflicts within the OR staff that led to its discontinuation at our institution.Future implementations of such programs should involve stakeholders early in the planning process to better address the needs of the OR staff.

Epidemiologic pattern of paediatric supracondylar fractures of humerus in a teaching hospital of rural India： A prospective study of 263 cases

Purpose： This prospective study aimed to investigate the epidemiologic parameters of supracondylar humeral fractures in children admitted to a teaching institution of a developing country primarily catering to rural population, to find any preventable cause of such injuries. Methods： All suspected cases of supracondylar humeral fracture reporting to emergency or outpatients department were analysed for various epidemiologic parameters including age, sex, laterality, time of presentation, associated injuries, neurovascular complications and classification over a period of four years. Results： We analysed a total of 263 patients and most of the fractures were seen in 5-8-year age group with a mean of 7.9 years. A total of 157 cases were males and non-dominant extremity was involved in 65% of fractures in our series. Fall on outstretched hand was the predominant cause of injury and fall from rooftop was the predominant mode. In all patients, 36.12% reported to our hospital 1 week after injury, 39.92% presented to hospital within 48 h after trauma and the remaining 23.95% presented 48 h to 1 week after trauma. None had a bilateral injury. Gartland type 3 fractures constituted 54.37% of patients, followed by type 1 （23.95%） and type 2 （21.67%）. Conclusion： Almost one fourth of supracondylar humeral fractures in children can be prevented by installing railing of rooftops and stairs. It is necessary to educate people on hazards of treatment by traditional bonesetters. Moreover, the children with supracondylar humeral fractures should be screened for associated injuries.

Iatrogenic brachial artery injury during pinning of supracondylar fracture of humerus： A rare injury

Complications following supracondylar fracture of humerus are well-known. Pre- and post-operative complications have been documented in the literature. Neumvascular injury due to fracture fragments following this type of fracture is described, latrogenic brachial artery during surgical treatment of this fracture is unknown to the literature. So we report a rare case of iatrogenic brachial artery injury during pinning of supracondylar fracture of humerus and try to create awareness to the surgeons that such injuries can occur with improper operative techniques.

rSO2-BIS监测在儿童肱骨髁上骨折手术中的应用研究

目的 探讨局部脑氧饱和度(regional cerebral oxygen saturation,rSO2)-脑电双频指数(bispectral index,BIS)监测麻醉方式在儿童肱骨髁上骨折手术中的应用。方法 选取江西省儿童医院骨科2020年1月至2022年12月收治的60例肱骨髁上骨折手术患儿,按随机数字表法分为对照组和观察组,每组30例。观察组患儿麻醉后给予rSO2-BIS监测,对照组患儿给予常规麻醉管理。结果 观察组患儿的丙泊酚中/长链脂肪乳和瑞芬太尼注射液用量明显少于对照组(P<0.05);患儿苏醒时各时间点的心率、血氧饱和度及平均动脉压比较,差异无统计学意义(P>0.05);术后镇痛药补救率低于对照组,拔管时间短于对照组(P<0.05);术后不良反应发生率及不良行为率低于对照组(P<0.001)。多因素分析结果发现丙泊酚中/长链脂肪乳和瑞芬太尼注射液的用量是诱发患儿术后出现不良反应和不良行为的独立危险因素,rSO2-BIS监测是减少患儿术后出现不良行为和不良反应的关键因素(P<0.05)。结论 儿童肱骨髁上骨折术中采用rSO2-BIS监测可降低手术患儿术后不良行为和不良反应的发生率,进而改善术后疗效。

儿童肱骨髁上骨折相关的神经损伤研究进展

本文综述了儿童肱骨髁上骨折相关的神经损伤的研究进展。首先讨论了不同类型的肱骨髁上骨折(伸直型、屈曲型及Gartland分型)与神经损伤之间的关系,接着分析了性别和侧别因素在神经损伤发生中的作用。在治疗方面,详细讨论了治疗时机的选择、损伤神经的恢复方法及不同的神经损伤治疗方式,最后对当前研究进行总结,并对未来的研究方向提出展望。

Multicentre collaborative cohort study of the use of Kirschner wires for the management of supracondylar fractures in children

Purpose:Supracondylar fractures of the humerus cause significant morbidity in children.Nerve damage and loss of fracture reduction are common recognised complications in patients with this injury.Uncertainty surrounds the optimal Kirschner wire configuration and diameter for closed reduction and pinning of these fractures.This study describes current practice and examined the association between wire configuration or diameter and outcomes(clinical and radiological)in the operative management of paediatric supracondylar fractures.Methods:Children presenting w让h GartlandⅡorⅢsupracondylar fractures at five hospitals in southwest England were eligible for inclusion.Collaborators scrutinised paper and electronic case notes.Outcome measures were maintenance of reduction and iatrogenic nerve injury.Results:Altogether 209 patients were eligible for inclusion:15.7%had a documented neurological deficit at presentation;3.9%who were neurologically intact at presentation sustained a new deficit caused by treatment and 13.4%experienced a clinically significant loss of reduction following fixation.Maintenance of reduction was significantly better in patients treated specifically with crossed×3 Kirschner wire configuration compared to all other configurations.The incidence of iatrogenic nerve injury was not significantly different between groups treated with different wire configurations.Conclusion:We present a large multicentre cohort study showing that crossed×3 Kirschner wires are associated with better maintenance of reduction than crossed×2 or lateral entry wires.Greater numbers would be required to properly investigate nerve injury relating to operative management of supracondylar fractures.We found significant variations in practice and compliance w让h the British Orthopaedic Association Standard for Trauma(BOAST)11 guidelines.