Amaral Jason Z, Schultz Rebecca J, Martin Benjamin M, Scioscia Jacob P, Touban Basel, Chhabra Barkha N, Cline Kelly, McKay Scott D
Department of Orthopaedic Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA.
Department of Orthopaedic Surgery, Wayne State University, Detroit, Michigan, USA.
Iowa Orthop J. 2024;44(2):77-82.
This study aims to determine the rate of surgical intervention in children with type IIA supracondylar humerus fractures (SCHF) following routine post-casting radiographic assessment. We hypothesized that no cases would convert to operative management following one-week post-casting alignment assessments.
This single-center retrospective study focused on pediatric patients diagnosed with type IIA SCHF from 2019 to 2022. Patients were treated with initial long arm cast immobilization, followed by a one-week post-casting radiographic alignment check in cast. Fractures were graded in consensus using the Wilkins-Modified Gartland classification system by three fellowship-trained pediatric orthopaedic surgeons. Demographics, casting details, follow-up dates, and treatment histories were examined. Alignment was considered acceptable or requiring surgery based on the treating surgeons' discretion. The study excluded patients with concomitant ipsilateral upper extremity fractures, flexion-type fractures, lost to follow-up before cast removal, or with type I, IIB or III SCHFs.
Of the 128 patients reviewed in our study, 85 were classified as type IIA SCHF by consensus. The cohort had an average age of 4.2 years (range: 1.1-10.2 years) and was 52% male. The patient population was ethnically diverse, with Hispanic patients constituting the majority (56%), followed by White patients (26%), Black patients (9%), and Asian patients (8%).Patients presented for definitive treatment an average of 2.8 days post-injury and spent an average of 28.8 days in casts. Alignment checks occurred an average of 10.3 days post-injury (SD ±2.5 days). Alignment shifts were noted in 7.1% of cases (n=6). Of these six cases, two were assessed by surgeons as having acceptable alignment, not requiring further intervention. The remaining four cases underwent closed reduction and percutaneous pinning. The rate of conversion to surgical treatment for type IIA supracondylar humerus fractures in our study was 4.7%.
This investigation found that 4.7% of nonoperative type IIA SCHFs converted to operative treatment at the one-week post-casting alignment check. Future studies are warranted to determine specific risk factors for alignment loss in type IIA SCHFs. .
本研究旨在确定在常规石膏固定后影像学评估后，IIA型肱骨髁上骨折（SCHF）患儿的手术干预率。我们假设在石膏固定一周后的对线评估后，不会有病例转为手术治疗。
这项单中心回顾性研究聚焦于2019年至2022年期间被诊断为IIA型SCHF的儿科患者。患者最初接受长臂石膏固定治疗，随后在石膏内进行为期一周的石膏固定后影像学对线检查。由三位接受过专科培训的儿科骨科医生使用Wilkins改良Gartland分类系统对骨折进行共识分级。检查了人口统计学资料、石膏固定细节、随访日期和治疗史。根据主刀医生的判断，将对线情况视为可接受或需要手术。该研究排除了伴有同侧上肢骨折、屈曲型骨折、在石膏拆除前失访或患有I型、IIB型或III型SCHF的患者。
在我们研究中审查的128例患者中，85例经共识分类为IIA型SCHF。该队列的平均年龄为4.2岁（范围：1.1 - 10.2岁），男性占52%。患者群体种族多样，西班牙裔患者占多数（56%），其次是白人患者（26%）、黑人患者（9%）和亚洲患者（8%）。患者平均在受伤后2.8天接受确定性治疗，平均石膏固定时间为28.8天。对线检查平均在受伤后10.3天进行（标准差±2.5天）。7.1%的病例（n = 6）出现了对线移位。在这6例病例中，有2例经外科医生评估对线可接受，无需进一步干预。其余4例接受了闭合复位和经皮穿针固定。在我们的研究中，IIA型肱骨髁上骨折转为手术治疗的比例为4.7%。
本调查发现，在石膏固定一周后的对线检查中，4.7%的非手术IIA型SCHF转为手术治疗。有必要进行进一步研究以确定IIA型SCHF对线丢失的具体危险因素。
