Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN.
J Pediatr Orthop. 2023 Jul 1;43(6):350-354. doi: 10.1097/BPO.0000000000002394. Epub 2023 Mar 20.
Treatment of supracondylar humerus (SCH) fractures within 18 hours of presentation is a tracked quality metric for ranking of pediatric hospitals. This is in contrast with literature that shows time to treatment does not impact outcomes in SCH fractures. We aim to determine whether an 18-hour cutoff for pediatric supracondylar humerus fracture treatment is clinically significant by comparing the complication risks ofpatients on either side of this timepoint. Our hypothesis is that there will be no statistically significant differences based on time to treatment.
A retrospective review of clinical outcomes was performed for 472 pediatric patients who underwent surgical management of isolated supracondylar humerus fractures between 1997 and 2022 at a single level I pediatric trauma hospital. The cohort was split based on time to surgery (within or ≥18 h from Emergency Department admission).
Surgical treatment occurred within 18 hours of arrival in 435 (92.2%) patients and after 18 hours in 37 (7.8%) patients. Mean age was 5.6±2.2 years and 51.5% of patients were female. Gartland fracture classification was type II [n=152 (32.3%)], type III [n=284 (60.3%)], type IV [n=13 (2.8%)], or flexion-type [n=18 (3.8%)]. There were no differences in demographic characteristics or fracture classification between cohorts. Fractures in the ≥18-hour cohort were treated more commonly with 2 pins (62.2% vs. 38.5%, P =0.04). There were no statistically significant differences in open versus closed reduction, utilization of medial pins, or postoperative immobilization between cohorts. We were unable to detect any differences in postoperative complications, including non-union, delayed union, stiffness, malunion, loss of reduction, iatrogenic nerve injury, or infection. This remained true when type II fractures were excluded.
Using an arbitrary time cutoff of <18 hours does not influence clinical outcomes in the surgical treatment of SCH fractures. This held true when type II fractures were excluded. For this reason, we recommend modification to the USNWR guidelines to decrease emphasis on time-to-treatment of SCH fractures.
Level III.
对于儿童医院的排名，在就诊后 18 小时内治疗肱骨髁上骨折（SCH）是一项跟踪的质量指标。这与文献中表明治疗时间不会影响 SCH 骨折结果的观点形成了对比。我们旨在通过比较处于此时间点两侧患者的并发症风险，确定儿童肱骨髁上骨折治疗的 18 小时截止时间是否具有临床意义。我们的假设是，基于治疗时间，不会有统计学上的显著差异。
对 1997 年至 2022 年期间在一家一级儿科创伤医院接受手术治疗的 472 例儿童 SCH 骨折患者的临床结果进行回顾性研究。该队列根据手术时间（急诊就诊后 18 小时内或≥18 小时）进行分组。
435 例（92.2%）患者在入院后 18 小时内接受手术治疗，37 例（7.8%）患者在 18 小时后接受手术治疗。平均年龄为 5.6±2.2 岁，51.5%的患者为女性。Gartland 骨折分型为 II 型[152 例（32.3%）]、III 型[284 例（60.3%）]、IV 型[13 例（2.8%）]或屈型[18 例（3.8%）]。两个队列在人口统计学特征或骨折分型方面没有差异。≥18 小时组中更常采用 2 枚钢针治疗（62.2%比 38.5%，P=0.04）。两组间在切开复位与闭合复位、内侧钢针使用或术后固定方面无统计学差异。我们无法检测到术后并发症（包括骨不连、延迟愈合、僵硬、畸形愈合、复位丢失、医源性神经损伤或感染）的差异。当排除 II 型骨折时，结果仍然如此。
在 SCH 骨折的手术治疗中，使用<18 小时的任意时间截止值不会影响临床结果。当排除 II 型骨折时，结果仍然如此。因此，我们建议修改 USNWR 指南，减少对 SCH 骨折治疗时间的重视。
III 级。
