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Outcomes of Pediatric Supracondylar Humerus Fractures Treated by Adult Hand Surgeons
Joshua Abzug, MD; Thao Nguyen; Ray Pensy; Andrew Eglseder; Vincent Pellegrini;
University of Maryland

Introduction: Supracondylar humerus (SCH) fractures are the most common elbow fracture in children. Type II and type III injuries require surgical treatment, usually with CRPP. Over the past decade, there has been an increasing trend toward the treatment of these injuries solely by pediatric orthopaedic surgeons. The purpose of this study is to determine differences in treatment strategies and outcomes of pediatric supracondylar humerus fractures treated by adult hand fellowship trained physicians.

Methods: A retrospective review was conducted analyzing the outcomes of type II and type III pediatric SCH fractures treated by orthopaedic hand surgeons over a 4-year period.

Results: The average age of the patients was 5 years (range 2-9), including 11 males and 12 females. Preoperatively, two patients had diminished pulses and two patients had neurologic injuries. Approximately three-quarters of the patients (73%) were treated within 12 hours of injury. Fifty six percent had a type III fracture with 30% of these being treated with ORIF. Three of the four patients underwent open reduction to obtain an adequate reduction as closed reduction maneuvers were felt to be inadequate, with the remaining patient undergoing brachial artery exploration without repair. Twenty six percent received at least one medial pin. The average time for removal of hardware was 4.3 weeks with 26% of patients having their hardware removed in the operating room. Forty percent were prescribed physical therapy. No patients had infection or compartment syndrome. Three patients had residual nerve palsies and five patients had cubitus varus (4 mild, 1 severe).

Conclusion: Adult orthopaedic hand surgeons can safely treat pediatric SCH fractures with a low complication rate. Compared to current pediatric literature, there is an increased utilization of open reduction techniques and medial pins, longer average time for removal of hardware, more hardware removal performed in the operating room, and more prescribed physical therapy.

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