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Displaced paediatric supracondylar humeral fractures pose a significant risk of neurovascular injury and consequently have traditionally been treated as a surgical emergency. Recently, the need for emergency surgery has been questioned. We wished to analyse our experience at a large UK tertiary paediatric trauma centre.A retrospective case note review was performed on patients with Gartland Grades 2 and 3 supracondylar fractures observed in a 2-year period from July 2008 to July 2010. We divided children into those treated before 12 h (early surgery) and after 12 h (delayed surgery). Analysis was undertaken using Fisher's exact test.Of the 137 patients, 115 were included in the study; median time-to-surgery was 15:30 (range 2:45-62:50); thirty-nine children were treated before 12 h and 76 patients after. In the early surgery group, three children (7.7%) developed a superficial pin-site infection, four children (10.3%) required open reduction, five children (12.8%) sustained an iatrogenic nerve injury, and two children (5%) required reoperation. In the delayed surgery group, one child (1.3%) had a superficial pin-site infection, four children (5.3%) required open reduction, seven children (9.2%) sustained an iatrogenic nerve injury, and two children (2.6%) reoperation. Bivariate analysis of our data using Fisher's exact t test revealed no statistically significant difference between early and delayed surgery groups with regard to infection rates (p = 0.1), iatrogenic nerve injury (p = 0.53) or need for open reduction (p = 0.44).Our results indicate that delayed surgery appears to offer a safe management approach in the treatment of displaced supracondylar fractures, but it is important that cases are carefully evaluated on an individual basis. These results indicate that patient transfer to a specialist paediatric centre, often with consequent surgical delay, is a safe management option and also negates the obligation to carry out these procedures at night.

Original publication

DOI

10.1007/s00590-013-1292-0

Type

Journal article

Journal

European journal of orthopaedic surgery & traumatology : orthopedie traumatologie

Publication Date

10/2014

Volume

24

Pages

1107 - 1110

Addresses

Department of Paediatric Trauma and Orthopaedic Surgery, Alder Hey Children's Hospital, Liverpool, L12 2AP, UK, alistairmayne@hotmail.co.uk.

Keywords

Elbow Joint, Humans, Surgical Wound Infection, Humeral Fractures, Fracture Fixation, Internal, Reoperation, Trauma Severity Indices, Retrospective Studies, Bone Nails, Time Factors, Adolescent, Child, Child, Preschool, Infant, Infant, Newborn, Trauma Centers, Intra-Articular Fractures, Peripheral Nerve Injuries, United Kingdom