Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute.
OrthoCarolina Pediatric Orthopaedic Center, Charlotte, NC.
J Pediatr Orthop. 2020 Nov/Dec;40(10):549-555. doi: 10.1097/BPO.0000000000001592.
Managing the pulseless pediatric supracondylar humerus fracture (PSHF) remains a significant clinical decision-making challenge for the treating surgeon. The purpose of the study is to determine frequency of the treatments according to the American Academy of Orthopaedic Surgeons (AAOS) Appropriate Use Criteria (AUC) for the PSHF with vascular injury and evaluate the appropriateness of these interventions.
We identified all PSHF with concern for vascular injury at one high volume, level 1 trauma center managed by 6 fellowship-trained pediatric orthopaedic surgeons over 4.5 years. Demographic information and other injury and treatment variables were obtained. Each patient was classified as 1 of the 6 patient scenarios specified by the AAOS AUC. Each of the 18 interventions identified in the AUC were documented, including the level of "appropriateness" as specified by AAOS AUC.
A total of 638 PSHF were managed identified; of these, 52 were pink, pulseless, or dysvascular (8.2%). Only 7 of the 18 treatment options suggested by the AUC were used in this cohort. Across all 7 interventions used in this cohort, 20.2% (17/84) of interventions were "appropriate," 52.4% (44/84) were "maybe appropriate," 22.6% (19/84) were "rarely appropriate," and 4.8% (4/84) were not listed in treatment options.
Supracondylar fractures are the most common injury to the elbow seen in children and are variable in presentation and management. The pink, pulseless fracture continues to be a major topic for research and discussion due to the morbidity if not treated "appropriately." The AUC were created to help guide practitioners when strong evidence is lacking. In this study at a single, pediatric hospital, there was variation and disagreement with "appropriateness" of treatments that were performed but this discrepancy did not result in any poor outcomes. Although the AUC do offer valuable guidance, our findings highlight a need for continued research in this area to help validate the AUC and help strengthen the recommendations moving forward.
Level III-retrospective.
对于治疗外科医生来说，管理无脉小儿髁上肱骨骨折（PSHF）仍然是一个重大的临床决策挑战。本研究的目的是根据美国骨科医师学会（AAOS）的适当使用标准（AUC）确定治疗伴有血管损伤的 PSHF 的治疗频率，并评估这些干预措施的适当性。
我们在一家高容量的 1 级创伤中心识别了所有伴有血管损伤的 PSHF，该中心由 6 名经过 fellowship培训的小儿矫形外科医生管理，历时 4.5 年。获得了人口统计学信息和其他损伤及治疗变量。每个患者均按照 AAOS AUC 规定的 6 种患者情况之一进行分类。记录了 AUC 中确定的 18 种干预措施中的每一种，包括 AAOS AUC 规定的“适当性”水平。
共管理了 638 例 PSHF，其中 52 例为粉红色、无脉搏或血管功能不良（8.2%）。只有 AUC 中建议的 18 种治疗方案中的 7 种在该队列中使用。在该队列中使用的所有 7 种干预措施中，20.2%（17/84）的干预措施是“适当的”，52.4%（44/84）是“可能适当的”，22.6%（19/84）是“很少适当的”，4.8%（4/84）不在治疗方案中。
髁上骨折是儿童肘部最常见的损伤，其表现和处理方式各不相同。粉红色、无脉搏的骨折由于治疗不当会导致发病率增加，因此仍然是一个主要的研究和讨论话题。AUC 的创建是为了在缺乏强有力证据的情况下帮助指导从业者。在一家儿科医院的这项研究中，尽管没有导致不良结果，但治疗的“适当性”存在差异和分歧。尽管 AUC 确实提供了有价值的指导，但我们的研究结果强调了在这一领域需要继续进行研究，以帮助验证 AUC 并为未来的建议提供支持。
III 级回顾性。
