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Delayed surgery leads to reduced elbow range of motion in children with supracondylar humeral fractures managed at a referral hospital in sub-Saharan Africa

BACKGROUND: Supracondylar humeral fractures (SHFs) in children are associated with morbidity due to elbow stiffness. Timely operative management and/or physiotherapy are thought to reduce this complication, but pose challenges in settings with limited resources for health. METHODS: This prospective...

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Autores principales: Masumbuko, Claude Kasereka, Mutheke, Edward Gakuya, Mbindyo, Benjamin, Hawkes, Michael T
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Makerere Medical School 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7040283/
https://www.ncbi.nlm.nih.gov/pubmed/32127829
http://dx.doi.org/10.4314/ahs.v19i3.32
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author Masumbuko, Claude Kasereka
Mutheke, Edward Gakuya
Mbindyo, Benjamin
Hawkes, Michael T
author_facet Masumbuko, Claude Kasereka
Mutheke, Edward Gakuya
Mbindyo, Benjamin
Hawkes, Michael T
author_sort Masumbuko, Claude Kasereka
collection PubMed
description BACKGROUND: Supracondylar humeral fractures (SHFs) in children are associated with morbidity due to elbow stiffness. Timely operative management and/or physiotherapy are thought to reduce this complication, but pose challenges in settings with limited resources for health. METHODS: This prospective cohort study included 45 pediatric patients with isolated SHF at a large tertiary hospital in Nairobi, Kenya. Patients were managed non-operatively or operatively with varying wait times to surgery, with or without physiotherapy. The measurement of elbow ROM was done up to 12 weeks after removal of Kirshner wires and/or backslab. RESULTS: Elbow ROM increased in the follow-up period, yet residual restricted mobility in the flexion-extension plane was common. Delayed surgical management ≥7 days was associated with reduced elbow ROM in the flexion-extension plane at 12 weeks median IQR 105° 92°–118° vs 120° 108°–124°, p=0.029. Physiotherapy was associated with reduced ROM at 12 weeks p=0.003, possibly due to the use of prolonged immobilization. CONCLUSION: In this study of pediatric SHFs at a resource-limited hospital, elbow flexion was restricted at 12 weeks follow-up and was associated with major delays in operative management. Quality of orthopedic surgical care and physiotherapy services in low-resource settings deserves further attention.
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spelling pubmed-70402832020-03-03 Delayed surgery leads to reduced elbow range of motion in children with supracondylar humeral fractures managed at a referral hospital in sub-Saharan Africa Masumbuko, Claude Kasereka Mutheke, Edward Gakuya Mbindyo, Benjamin Hawkes, Michael T Afr Health Sci Articles BACKGROUND: Supracondylar humeral fractures (SHFs) in children are associated with morbidity due to elbow stiffness. Timely operative management and/or physiotherapy are thought to reduce this complication, but pose challenges in settings with limited resources for health. METHODS: This prospective cohort study included 45 pediatric patients with isolated SHF at a large tertiary hospital in Nairobi, Kenya. Patients were managed non-operatively or operatively with varying wait times to surgery, with or without physiotherapy. The measurement of elbow ROM was done up to 12 weeks after removal of Kirshner wires and/or backslab. RESULTS: Elbow ROM increased in the follow-up period, yet residual restricted mobility in the flexion-extension plane was common. Delayed surgical management ≥7 days was associated with reduced elbow ROM in the flexion-extension plane at 12 weeks median IQR 105° 92°–118° vs 120° 108°–124°, p=0.029. Physiotherapy was associated with reduced ROM at 12 weeks p=0.003, possibly due to the use of prolonged immobilization. CONCLUSION: In this study of pediatric SHFs at a resource-limited hospital, elbow flexion was restricted at 12 weeks follow-up and was associated with major delays in operative management. Quality of orthopedic surgical care and physiotherapy services in low-resource settings deserves further attention. Makerere Medical School 2019-09 /pmc/articles/PMC7040283/ /pubmed/32127829 http://dx.doi.org/10.4314/ahs.v19i3.32 Text en © 2019 Masumbuko et al. Licensee African Health Sciences. This is an Open Access article distributed under the terms of the Creative commons Attribution License (https://creativecommons.org/licenses/BY/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Articles
Masumbuko, Claude Kasereka
Mutheke, Edward Gakuya
Mbindyo, Benjamin
Hawkes, Michael T
Delayed surgery leads to reduced elbow range of motion in children with supracondylar humeral fractures managed at a referral hospital in sub-Saharan Africa
title Delayed surgery leads to reduced elbow range of motion in children with supracondylar humeral fractures managed at a referral hospital in sub-Saharan Africa
title_full Delayed surgery leads to reduced elbow range of motion in children with supracondylar humeral fractures managed at a referral hospital in sub-Saharan Africa
title_fullStr Delayed surgery leads to reduced elbow range of motion in children with supracondylar humeral fractures managed at a referral hospital in sub-Saharan Africa
title_full_unstemmed Delayed surgery leads to reduced elbow range of motion in children with supracondylar humeral fractures managed at a referral hospital in sub-Saharan Africa
title_short Delayed surgery leads to reduced elbow range of motion in children with supracondylar humeral fractures managed at a referral hospital in sub-Saharan Africa
title_sort delayed surgery leads to reduced elbow range of motion in children with supracondylar humeral fractures managed at a referral hospital in sub-saharan africa
topic Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7040283/
https://www.ncbi.nlm.nih.gov/pubmed/32127829
http://dx.doi.org/10.4314/ahs.v19i3.32
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