title: Closed reduction and stabilization of supracondylar fractures of the humerus in children: the crucial factor of surgical experience.
abstract: We reviewed the outcome following operative management of displaced (Gartland II and III) supracondylar fractures of the humerus in children over a 2-year period and tried to correlate the outcome with various factors including experience of the treating surgeon. Of the 71 children who formed the study group, 62 (87.3%) had a good outcome irrespective of the treatment modality. Closed reduction followed by plaster immobilization or percutaneous pinning resulted in a better outcome than open reduction. There was a direct involvement of the consultant in the primary management of these injuries in 17 cases (24%), none of which had a poor outcome. Of the 54 cases in whom the primary management was carried out independently by trainees without any consultant supervision, nine patients (17%) developed complications or needed reoperations. The proportion of unsatisfactory outcomes increased to 20.3% when failure to achieve a satisfactory reduction by closed means was also considered as a perioperative complication. There is a learning curve associated with percutaneous pinning after closed reduction and experience of the surgeon seems to be one of the factors that have an influence on the outcome.
authors.affiliation: Department of Paediatric Orthopaedics and Trauma Surgery, Sheffield Children's Hospital, UK.
authors.forename: Manoj
authors.initials: M
authors.lastname: Padman
authors.forename: Andrea M
authors.initials: AM
authors.lastname: Warwick
authors.forename: James A
authors.initials: JA
authors.lastname: Fernandes
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Flowers
authors.forename: Anthony G
authors.initials: AG
authors.lastname: Davies
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Bell
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence; D005260:Female; D005592:Fracture Fixation / Q000379:methods*; D013502:General Surgery; D006801:Humans; D006810:Humeral Fractures / Q000628:therapy*; D007103:Immobilization / Q000379:methods*; D007223:Infant; D008297:Male; D016896:Treatment Outcome