Saarinen A J, Helenius I
Department of Paediatric Orthopaedic Surgery, University of Turku and Turku University Hospital, Turku, Finland.
J Child Orthop. 2019 Feb 1;13(1):40-46. doi: 10.1302/1863-2548.13.180083.
The effect of surgical specialty on the outcomes of paediatric patients treated for displaced supracondylar humeral fractures remains unclear. The results of residents, paediatric surgeons and orthopaedic surgeons were compared.
A retrospective review of 108 children (0 to 16 years) treated for displaced humeral supracondylar fractures (Gartland II or III) requiring closed or open reduction under general anaesthesia were included. The patient charts and radiographs were evaluated to identify type, grade and neurovascular complications. Operative performance (operative time, quality of reduction, need for open reduction, complications) of residents, paediatric surgeons and orthopaedic surgeons were evaluated.
Residents used a crossed pin configuration for patients in 25/25 (100%), paediatric surgeons in 25/32 (78%) and orthopaedic surgeons in 33/33 (100%) (p = 0.0011). Loss of reduction was present in one patient treated with crossed pins, in two with lateral pins and in two without Kirschner-wires (p = 0.0034). The risk ratio of an unacceptable reduction was 4.0 (95% confidence interval (CI) 0.90 to 18, p = 0.070) for residents and 6.6 (95% CI 1.6 to 27, p = 0.0082) for paediatric surgeons as compared with orthopaedic surgeons. Complications were present in 37% of patients (11/30) for residents, 55% (24/44) for paediatric surgeons and 15% (5/34) for orthopaedic surgeons (p = 0.0013).
We found statistically significant differences in the incidence of unacceptable reduction, complications and the usage of crossed pin configuration between the surgical specialties. Patients would benefit from the practice of assigning the operative treatment of displaced supracondylar fractures to orthopaedic surgeons.
Level III.
外科专业对小儿肱骨髁上骨折移位患者治疗结果的影响尚不清楚。比较了住院医师、小儿外科医生和骨科医生的治疗结果。
回顾性分析108例（0至16岁）因肱骨髁上骨折移位（Gartland II或III型）需在全身麻醉下进行闭合或切开复位治疗的儿童。评估患者病历和X线片以确定骨折类型、分级及神经血管并发症。评估住院医师、小儿外科医生和骨科医生的手术操作情况（手术时间、复位质量、切开复位需求、并发症）。
住院医师对25/25例（100%）患者采用交叉克氏针固定，小儿外科医生对25/32例（78%）患者采用交叉克氏针固定，骨科医生对33/33例（100%）患者采用交叉克氏针固定（p = 0.0011）。1例采用交叉克氏针固定的患者出现复位丢失，2例采用外侧克氏针固定的患者出现复位丢失，2例未用克氏针固定的患者出现复位丢失（p = 0.0034）。与骨科医生相比，住院医师复位效果不佳的风险比为4.0（95%置信区间（CI）0.90至18，p = 0.070），小儿外科医生为6.6（95%CI 1.6至27，p = 0.0082）。住院医师治疗的患者中有37%（11/30）出现并发症，小儿外科医生治疗的患者中有55%（24/44）出现并发症，骨科医生治疗的患者中有15%（5/34）出现并发症（p = 0.0013）。
我们发现各外科专业在复位效果不佳的发生率、并发症及交叉克氏针固定的使用方面存在统计学显著差异。将肱骨髁上骨折移位的手术治疗分配给骨科医生进行，患者将从中受益。
III级。
