[Supracondylar humerus fracture in childhood--an efficacy study. Results of a multicenter study by the Pediatric Traumatology Section of the German Society of Trauma Surgery--II: Costs and effectiveness of the treatment].
The following are the results and conclusions of a retrospective research study done on 886 patients with supracondylar fractures of the humerus. The study evaluates how effective the treatment procedures of the fractures are. The patients' fractures were categorized into four groups. It made it easier to differentiate between dislocated and undislocated fractures (see part I Weinberg A et al.). The following parameters were established to evaluate the treatment procedures and to create relevancy to the final outcome depending on the degree of difficulty of the fractures: Length of hospitalization, amount of repositioning procedures (including if an open or closed procedure was needed), amount of post repositioning procedures and the recommended change of therapy, method of retention and fixation, necessary metal removal, amount of check ups needed. The amount of x-ray exams could not be established due to insufficient documentation. The study showed a rather random pattern regarding length of hospitalization and the amount of check ups especially among type I and II patients. Open versus closed repositioning procedures did not seem to be advantageous. The implanted wires did not prevent infections. It just increased the treatment procedure by another hospitalization and anesthesia to remove the implanted wires. Physical therapy was not necessary and was only prescribed in cases of prolonged immobilization. The results of this study generated consequences regarding treatment procedures and developed a more efficient treatment protocol: Type I and II (dislocated and undislocated fractures in one plane) will be treated conservatively on an out-patient basis. Type I in a cast. Type II in a blount or plaster cast with flexed angle between 100 degrees and 130 degrees. Type III an IV (dislocated and undislocated fractures in two or three planes) will be treated if possible with a closed repositioning procedure. Otherwise a close repositioning procedure will be necessary and followed with some kind of KD-osteosynthese to capture the fracture. The patient will be hospitalized for a short period. The blount procedure will not be sufficient for this type of fracture. Therapy and procedure will be translated put in a perspective research study.
von Laer
L
L
Universitätskinderkliniken beider Basel, Basel, Schweiz. Lutze@balcab.ch
Günter
S M
SM
Knopf
S
S
Weinberg
Annelie M
AM
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D004551:Elbow Joint / Q000601:surgery; D005260:Female; D005593:Fracture Fixation, Internal / Q000191:economics*; D005597:Fractures, Open / Q000145:classification / Q000191:economics* / Q000601:surgery; D005858:Germany; D006801:Humans; D006810:Humeral Fractures / Q000145:classification / Q000191:economics* / Q000601:surgery; D007223:Infant; D007902:Length of Stay / Q000191:economics; D008297:Male; D012086:Reoperation / Q000191:economics; D012189:Retrospective Studies; D016896:Treatment Outcome; D000092464:Elbow Injuries