Gartland type III supracondylar humerus fractures: outcome and complications as related to operative timing and pin configuration

Matthew D. Abbott, Lucas Buchler, Randall T. Loder, Christine B. Caltoum

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

Purpose : Supracondylar fractures of the humerus are the most common fracture of theelbow in children. The purpose of this study was to evaluate, in terms of outcomes andcomplications, Gartland type III pediatric supracondylar humerus fractures treated at apediatric level-one trauma center over a 7-year period, specifically addressing theimpact of time to surgery on the incidence of complications and conversion to openreduction.

Methods: We retrospectively reviewed 297 pediatric patients that sustained a closedGartland type III supracondylar humerus fracture treated between December 2004 andDecember 2011. The time to the operating room was calculated from the medical recordsfor each patient. The outcome measures evaluated were operative time, conversion toopen procedure, and perioperative and postoperative complications.

Results: In our study, there were 30 complications in 25 children (8.4%). Conversion to open reduction occurred in 28 children (9.4%). The time from the emergency department to the operating room was not significantly correlated with increased complications, increased operative time, or conversion to open reduction (p > 0.05). Crossed pinning resulted in an increased risk of overall complications [odds ratio (OR) = 2.6] and iatrogenic nerve injuries (OR = 9.3). Complications also occurred more commonly in boys (OR = 3.3) and in older patients (p = 0.0069).

Conclusions: We found no significant correlation between the time to surgery andcomplications, operative time, or need for open reduction. These findings support thetrend of treating Gartland type III supracondylar humerus fractures in a less urgentmanner. In addition, our study supports the concept that cross pinning leads to morecomplications than lateral pinning, including an 8-fold increase in iatrogenic nerveinjury.

Original languageEnglish (US)
Pages (from-to)473-477
Number of pages5
JournalJournal of Children's Orthopaedics
Volume8
Issue number6
DOIs
StatePublished - Dec 3 2014

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Humerus
Operative Time
Odds Ratio
Operating Rooms
Pediatrics
Trauma Centers
Hospital Emergency Service
Outcome Assessment (Health Care)
Incidence
Wounds and Injuries

Keywords

  • Humerus
  • Pediatric
  • Supracondylar
  • Trauma

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Pediatrics, Perinatology, and Child Health

Cite this

@article{3e473558ee39448184a0e27960d867e0,
title = "Gartland type III supracondylar humerus fractures: outcome and complications as related to operative timing and pin configuration",
abstract = "Purpose : Supracondylar fractures of the humerus are the most common fracture of theelbow in children. The purpose of this study was to evaluate, in terms of outcomes andcomplications, Gartland type III pediatric supracondylar humerus fractures treated at apediatric level-one trauma center over a 7-year period, specifically addressing theimpact of time to surgery on the incidence of complications and conversion to openreduction.Methods: We retrospectively reviewed 297 pediatric patients that sustained a closedGartland type III supracondylar humerus fracture treated between December 2004 andDecember 2011. The time to the operating room was calculated from the medical recordsfor each patient. The outcome measures evaluated were operative time, conversion toopen procedure, and perioperative and postoperative complications.Results: In our study, there were 30 complications in 25 children (8.4{\%}). Conversion to open reduction occurred in 28 children (9.4{\%}). The time from the emergency department to the operating room was not significantly correlated with increased complications, increased operative time, or conversion to open reduction (p > 0.05). Crossed pinning resulted in an increased risk of overall complications [odds ratio (OR) = 2.6] and iatrogenic nerve injuries (OR = 9.3). Complications also occurred more commonly in boys (OR = 3.3) and in older patients (p = 0.0069).Conclusions: We found no significant correlation between the time to surgery andcomplications, operative time, or need for open reduction. These findings support thetrend of treating Gartland type III supracondylar humerus fractures in a less urgentmanner. In addition, our study supports the concept that cross pinning leads to morecomplications than lateral pinning, including an 8-fold increase in iatrogenic nerveinjury.",
keywords = "Humerus, Pediatric, Supracondylar, Trauma",
author = "Abbott, {Matthew D.} and Lucas Buchler and Loder, {Randall T.} and Caltoum, {Christine B.}",
year = "2014",
month = "12",
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doi = "10.1007/s11832-014-0624-x",
language = "English (US)",
volume = "8",
pages = "473--477",
journal = "Journal of Children's Orthopaedics",
issn = "1863-2521",
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TY - JOUR

T1 - Gartland type III supracondylar humerus fractures

T2 - outcome and complications as related to operative timing and pin configuration

AU - Abbott, Matthew D.

AU - Buchler, Lucas

AU - Loder, Randall T.

AU - Caltoum, Christine B.

PY - 2014/12/3

Y1 - 2014/12/3

N2 - Purpose : Supracondylar fractures of the humerus are the most common fracture of theelbow in children. The purpose of this study was to evaluate, in terms of outcomes andcomplications, Gartland type III pediatric supracondylar humerus fractures treated at apediatric level-one trauma center over a 7-year period, specifically addressing theimpact of time to surgery on the incidence of complications and conversion to openreduction.Methods: We retrospectively reviewed 297 pediatric patients that sustained a closedGartland type III supracondylar humerus fracture treated between December 2004 andDecember 2011. The time to the operating room was calculated from the medical recordsfor each patient. The outcome measures evaluated were operative time, conversion toopen procedure, and perioperative and postoperative complications.Results: In our study, there were 30 complications in 25 children (8.4%). Conversion to open reduction occurred in 28 children (9.4%). The time from the emergency department to the operating room was not significantly correlated with increased complications, increased operative time, or conversion to open reduction (p > 0.05). Crossed pinning resulted in an increased risk of overall complications [odds ratio (OR) = 2.6] and iatrogenic nerve injuries (OR = 9.3). Complications also occurred more commonly in boys (OR = 3.3) and in older patients (p = 0.0069).Conclusions: We found no significant correlation between the time to surgery andcomplications, operative time, or need for open reduction. These findings support thetrend of treating Gartland type III supracondylar humerus fractures in a less urgentmanner. In addition, our study supports the concept that cross pinning leads to morecomplications than lateral pinning, including an 8-fold increase in iatrogenic nerveinjury.

AB - Purpose : Supracondylar fractures of the humerus are the most common fracture of theelbow in children. The purpose of this study was to evaluate, in terms of outcomes andcomplications, Gartland type III pediatric supracondylar humerus fractures treated at apediatric level-one trauma center over a 7-year period, specifically addressing theimpact of time to surgery on the incidence of complications and conversion to openreduction.Methods: We retrospectively reviewed 297 pediatric patients that sustained a closedGartland type III supracondylar humerus fracture treated between December 2004 andDecember 2011. The time to the operating room was calculated from the medical recordsfor each patient. The outcome measures evaluated were operative time, conversion toopen procedure, and perioperative and postoperative complications.Results: In our study, there were 30 complications in 25 children (8.4%). Conversion to open reduction occurred in 28 children (9.4%). The time from the emergency department to the operating room was not significantly correlated with increased complications, increased operative time, or conversion to open reduction (p > 0.05). Crossed pinning resulted in an increased risk of overall complications [odds ratio (OR) = 2.6] and iatrogenic nerve injuries (OR = 9.3). Complications also occurred more commonly in boys (OR = 3.3) and in older patients (p = 0.0069).Conclusions: We found no significant correlation between the time to surgery andcomplications, operative time, or need for open reduction. These findings support thetrend of treating Gartland type III supracondylar humerus fractures in a less urgentmanner. In addition, our study supports the concept that cross pinning leads to morecomplications than lateral pinning, including an 8-fold increase in iatrogenic nerveinjury.

KW - Humerus

KW - Pediatric

KW - Supracondylar

KW - Trauma

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U2 - 10.1007/s11832-014-0624-x

DO - 10.1007/s11832-014-0624-x

M3 - Article

AN - SCOPUS:84916880857

VL - 8

SP - 473

EP - 477

JO - Journal of Children's Orthopaedics

JF - Journal of Children's Orthopaedics

SN - 1863-2521

IS - 6

ER -