TY - JOUR
T1 - Management of pediatric type III supracondylar humerus fractures in the United States
T2 - Results of a national survey of pediatric orthopaedic surgeons
AU - Carter, Craig T.
AU - Bertrand, Styles L.
AU - Cearley, David M.
PY - 2013/10
Y1 - 2013/10
N2 - BACKGROUND: Supracondylar humerus fractures are common injuries in the pediatric population. The most severe, type III injuries, have seen the most debate on treatment regimens. Traditionally, these fractures were treated as surgical emergencies, most often fixed with percutaneous pinning in a cross-pin configuration. The recent literature shows that delayed fixation is comparable to emergent fixation as long as there is no vascular compromise with the injury. METHODS: A short survey was sent to Pediatric Orthopaedic Society of North America (POSNA) members using an online survey and questionnaire service. The purpose of the survey was to establish an overview of current practices in the United States concerning treatment of type III supracondylar humerus fractures and the influence of the recent literature on the management of these injuries. RESULTS: A total of 309 members, representing a wide range of locations and years in practice, responded to our survey. About 81% preferred to splint type III supracondylar humerus fractures and plan for fixation the following morning, assuming there was no issue necessitating emergent fixation. The preferred method of percutaneous fixation was fairly evenly distributed between cross-pin configuration (30%), 2 lateral pins (33%), and 3 lateral pins (37%). About 56% of those surveyed stated that the recent literature showing comparable outcomes with 2 lateral pins versus a cross-pin configuration had not changed their approaches to management of these fractures concerning the method of fixation. CONCLUSIONS: The trend in management of type III supracondylar humerus fractures in children is progressing toward delayed treatment and lateral pin configuration. The results provide an overview of the current practice of POSNA members concerning management of these fractures. We believe this information is beneficial to both pediatric-trained and nonpediatric-trained orthopaedic surgeons to help guide their decisions when dealing with these injuries.
AB - BACKGROUND: Supracondylar humerus fractures are common injuries in the pediatric population. The most severe, type III injuries, have seen the most debate on treatment regimens. Traditionally, these fractures were treated as surgical emergencies, most often fixed with percutaneous pinning in a cross-pin configuration. The recent literature shows that delayed fixation is comparable to emergent fixation as long as there is no vascular compromise with the injury. METHODS: A short survey was sent to Pediatric Orthopaedic Society of North America (POSNA) members using an online survey and questionnaire service. The purpose of the survey was to establish an overview of current practices in the United States concerning treatment of type III supracondylar humerus fractures and the influence of the recent literature on the management of these injuries. RESULTS: A total of 309 members, representing a wide range of locations and years in practice, responded to our survey. About 81% preferred to splint type III supracondylar humerus fractures and plan for fixation the following morning, assuming there was no issue necessitating emergent fixation. The preferred method of percutaneous fixation was fairly evenly distributed between cross-pin configuration (30%), 2 lateral pins (33%), and 3 lateral pins (37%). About 56% of those surveyed stated that the recent literature showing comparable outcomes with 2 lateral pins versus a cross-pin configuration had not changed their approaches to management of these fractures concerning the method of fixation. CONCLUSIONS: The trend in management of type III supracondylar humerus fractures in children is progressing toward delayed treatment and lateral pin configuration. The results provide an overview of the current practice of POSNA members concerning management of these fractures. We believe this information is beneficial to both pediatric-trained and nonpediatric-trained orthopaedic surgeons to help guide their decisions when dealing with these injuries.
KW - Pediatric type III supracondylar humerus fracture
KW - injury management
KW - method of fixation
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U2 - 10.1097/BPO.0b013e31829f92f3
DO - 10.1097/BPO.0b013e31829f92f3
M3 - Article
C2 - 24025582
AN - SCOPUS:84884664079
SN - 0271-6798
VL - 33
SP - 750
EP - 754
JO - Journal of Pediatric Orthopaedics
JF - Journal of Pediatric Orthopaedics
IS - 7
ER -