Wagner Ferdinand, Boeriu Amalia, Eberz Pascal, Weigert Annabelle, Holzapfel Boris Michael, Böcker Wolfgang, Hubertus Jochen, Muensterer Oliver, Bergmann Florian, Ziegler Christian Max
Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, Ludwig-Maximilians-Universität München, Marchioninistrasse 15, 81377 Munich, Germany.
Institute of Health and Biomedical Innovation, Queensland University of Technology (QUT), Brisbane, QLD 4059, Australia.
Children (Basel). 2023 Dec 26;11(1):27. doi: 10.3390/children11010027.
To assess changes in treatment modalities for supracondylar humerus fractures (SCHFs) at a large pediatric university hospital, we analyzed patient data from 2014 to 2022. A total of 233 SCHFs treated surgically at our hospital were included. To evaluate postoperative outcome and quality of life, DASH and EuroQol-5D-Y questionnaires were sent to patients. In addition to a significant fluctuation in fracture severity, we found an increase in training interventions (more surgeries were performed by trainees) and a significant decrease in surgery times after 2016. From 2020, there was a significant shift in the type of surgical method away from closed reduction with elastic stable intramedullary nailing (ESIN) and towards closed reduction and crossed K-wire osteosynthesis (CRK). Surgeries performed in the morning and evening hours increased, while those performed in the afternoon and after midnight decreased. After a mean follow-up of 4 years, there was no difference in elbow function between ESIN and open reduction and K-wires (ORK). Treatment with ESIN was equivalent to ORK in terms of function, at least in the medium-term follow-up. In summary, the combination of shifting treatment from SCHF to daytime hours, increasing trainee participation and using cross K-wire fixation instead of ESIN had no negative impact on surgery times. In our setting, these measures have reduced resource utilization and increased efficiency without compromising patient care.
为评估一家大型儿科大学医院治疗肱骨髁上骨折（SCHF）的治疗方式变化，我们分析了2014年至2022年的患者数据。纳入了我院共233例接受手术治疗的SCHF患者。为评估术后结果和生活质量，向患者发送了上肢功能障碍评定量表（DASH）和欧洲五维健康量表（EuroQol-5D-Y）问卷。除骨折严重程度有显著波动外，我们发现2016年后培训干预有所增加（更多手术由实习生进行）且手术时间显著缩短。从2020年起，手术方法类型发生了显著转变，从弹性稳定髓内钉固定（ESIN）闭合复位转向闭合复位交叉克氏针内固定（CRK）。上午和晚上进行的手术增加，而下午和午夜后进行的手术减少。平均随访4年后，ESIN与切开复位克氏针内固定（ORK）在肘关节功能方面无差异。至少在中期随访中，ESIN治疗在功能方面与ORK相当。总之，将SCHF治疗时间转移到白天、增加实习生参与度以及使用交叉克氏针固定而非ESIN的综合措施对手术时间没有负面影响。在我们的环境中，这些措施在不影响患者护理的情况下减少了资源利用并提高了效率。
