Department of Orthopaedics, University of Colorado School of Medicine, Aurora.
Department of Orthopedic Surgery, Children's Hospital Colorado, Anschutz, CO.
J Pediatr Orthop. 2022;42(5):e470-e473. doi: 10.1097/BPO.0000000000002115.
The primary purpose of this analysis was to compare supracondylar humerus fracture (SCHF) treatment patterns at a single quaternary pediatric hospital relative to the American Academy of Orthopedic Surgeons (AAOS) appropriate use treatment recommendation(s).
Among all fractures included in the cohort (n=571), the observed treatment approach was evaluated relative to the AAOS "Appropriate" treatment recommendation(s). The proportion, and corresponding 95% confidence interval, of cases that agreed with the "Appropriate" treatment recommendation was estimated. Demographics and clinical characteristics among cases that were managed in accordance with the "Appropriate," "May be Appropriate," or "Rarely Appropriate" were compared.
All fractures were treated according to the "Appropriate," "May be Appropriate," or "Rarely Appropriate" AAOS treatment guidelines. The observed treatment among fractures included in the cohort agreed with AAOS "Appropriate" recommendations in 92.1% [95% confidence interval (CI): 89.6%-94.2%] of the cases. Fracture type differed significantly between patients treated according to AAOS "Appropriate" recommendations compared to those treated according to "May be Appropriate," or "Rarely Appropriate" recommendation.
The treatment approach implemented at a single level 1 trauma center was in concordance with the appropriate use criteria treatment recommendations in a significant majority of cases. Fractures not treated according to "Appopriate" recommendations were primarily type IIA injuries, and were treated with closed reduction and casting instead of the recommended closed reduction and percutaneous pinning.
Level III.
本分析的主要目的是比较一家四级儿科医院的肱骨髁上骨折（SCHF）治疗模式与美国骨科医师学会（AAOS）的适当使用治疗建议。
在纳入的所有骨折病例中（n=571），评估观察到的治疗方法与 AAOS 的“适当”治疗建议相符的程度。估计符合“适当”治疗建议的病例比例及其相应的 95%置信区间。比较符合“适当”、“可能适当”或“很少适当”治疗建议的病例的人口统计学和临床特征。
所有骨折均根据 AAOS 的“适当”、“可能适当”或“很少适当”治疗指南进行治疗。队列中纳入的骨折的观察治疗与 AAOS 的“适当”建议一致，占 92.1%[95%置信区间（CI）：89.6%-94.2%]。根据 AAOS“适当”建议治疗的患者与根据“可能适当”或“很少适当”建议治疗的患者之间，骨折类型存在显著差异。
在一家一级创伤中心实施的治疗方法与大多数情况下的适当使用标准治疗建议一致。未根据“适当”建议治疗的骨折主要为 IIA 型损伤，采用闭合复位和石膏固定治疗，而不是推荐的闭合复位和经皮钢针固定。
III 级。
