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Fully displaced pediatric supracondylar humerus fractures: Which ones need to go at night?

BACKGROUND: Challenges remain in determining which displaced supracondylar humerus fractures are safe to postpone surgical treatment until daylight hours. The purpose of this study is to determine which characteristics can be identified to guide the timing of treatment of supracondylar humerus fract...

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Autores principales: Mahan, Susan T, Miller, Patricia E, Park, Jiwoo, Sullivan, Nicholas, Vuillermin, Carley
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9550999/
https://www.ncbi.nlm.nih.gov/pubmed/36238148
http://dx.doi.org/10.1177/18632521221119540
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author Mahan, Susan T
Miller, Patricia E
Park, Jiwoo
Sullivan, Nicholas
Vuillermin, Carley
author_facet Mahan, Susan T
Miller, Patricia E
Park, Jiwoo
Sullivan, Nicholas
Vuillermin, Carley
author_sort Mahan, Susan T
collection PubMed
description BACKGROUND: Challenges remain in determining which displaced supracondylar humerus fractures are safe to postpone surgical treatment until daylight hours. The purpose of this study is to determine which characteristics can be identified to guide the timing of treatment of supracondylar humerus fractures. METHODS: 225 completely displaced Gartland extension type 3/4 supracondylar humerus fractures in healthy patients that presented between 6 am and 7 am were identified. Data were collected retrospectively. Data analysis included univariate, multivariable logistic regression and classification and regression tree analysis. RESULTS: 5% (78/225) underwent surgical treatment the night they presented, while 65% (147/225) were treated the next day. Overall complication rate was 6%, with no difference based on timing of surgery. 12% (28/225) presented with a motor nerve injury, while 6% (14/225) a “pink pulseless” extremity. Statistical analysis found the most reliable radiographic predictor to be the maximum displacement on the anterior–posterior or lateral view. Classification and regression tree analysis developed a clinical algorithm; patients with a “pink pulseless” extremity or motor nerve injury were recommended for surgery overnight, while those with an anterior–posterior or lateral view < 25 mm were recommended for surgery the next day. CONCLUSION: This study provides guidance on the timing of treatment for displaced supracondylar humerus fractures that present overnight. We provide a simple algorithm with three key clinical predictors for timing of treatment: presence of a “pink pulseless” arm, presence of a motor nerve injury, and displacement of any cortex by at least 25 mm (anterior–posterior or lateral view). This provides a step forward to help practitioners make safer evidenced-based timing decisions for their patients. LEVEL OF EVIDENCE: Prognostic Study, Level II.
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spelling pubmed-95509992022-10-12 Fully displaced pediatric supracondylar humerus fractures: Which ones need to go at night? Mahan, Susan T Miller, Patricia E Park, Jiwoo Sullivan, Nicholas Vuillermin, Carley J Child Orthop Trauma BACKGROUND: Challenges remain in determining which displaced supracondylar humerus fractures are safe to postpone surgical treatment until daylight hours. The purpose of this study is to determine which characteristics can be identified to guide the timing of treatment of supracondylar humerus fractures. METHODS: 225 completely displaced Gartland extension type 3/4 supracondylar humerus fractures in healthy patients that presented between 6 am and 7 am were identified. Data were collected retrospectively. Data analysis included univariate, multivariable logistic regression and classification and regression tree analysis. RESULTS: 5% (78/225) underwent surgical treatment the night they presented, while 65% (147/225) were treated the next day. Overall complication rate was 6%, with no difference based on timing of surgery. 12% (28/225) presented with a motor nerve injury, while 6% (14/225) a “pink pulseless” extremity. Statistical analysis found the most reliable radiographic predictor to be the maximum displacement on the anterior–posterior or lateral view. Classification and regression tree analysis developed a clinical algorithm; patients with a “pink pulseless” extremity or motor nerve injury were recommended for surgery overnight, while those with an anterior–posterior or lateral view < 25 mm were recommended for surgery the next day. CONCLUSION: This study provides guidance on the timing of treatment for displaced supracondylar humerus fractures that present overnight. We provide a simple algorithm with three key clinical predictors for timing of treatment: presence of a “pink pulseless” arm, presence of a motor nerve injury, and displacement of any cortex by at least 25 mm (anterior–posterior or lateral view). This provides a step forward to help practitioners make safer evidenced-based timing decisions for their patients. LEVEL OF EVIDENCE: Prognostic Study, Level II. SAGE Publications 2022-08-26 2022-10 /pmc/articles/PMC9550999/ /pubmed/36238148 http://dx.doi.org/10.1177/18632521221119540 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by-nc/4.0/This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page(https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Trauma
Mahan, Susan T
Miller, Patricia E
Park, Jiwoo
Sullivan, Nicholas
Vuillermin, Carley
Fully displaced pediatric supracondylar humerus fractures: Which ones need to go at night?
title Fully displaced pediatric supracondylar humerus fractures: Which ones need to go at night?
title_full Fully displaced pediatric supracondylar humerus fractures: Which ones need to go at night?
title_fullStr Fully displaced pediatric supracondylar humerus fractures: Which ones need to go at night?
title_full_unstemmed Fully displaced pediatric supracondylar humerus fractures: Which ones need to go at night?
title_short Fully displaced pediatric supracondylar humerus fractures: Which ones need to go at night?
title_sort fully displaced pediatric supracondylar humerus fractures: which ones need to go at night?
topic Trauma
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9550999/
https://www.ncbi.nlm.nih.gov/pubmed/36238148
http://dx.doi.org/10.1177/18632521221119540
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