title: An inconvenient truth: treatment of displaced paediatric supracondylar humeral fractures.
abstract: The need for emergent management of displaced paediatric supracondylar humeral fractures is being questioned in the literature. Open reduction rates of up to 46% have been reported in the non-emergent management of these injuries. At our institution these fractures are managed as operative emergencies by senior personnel. To examine the ongoing need for this policy we reviewed our results. All patients managed over a five year period with Gartland type IIB or III paeditric supracondylar humeral fractures were identified and a comprehensive chart and radiographic review undertaken. The mean time from injury to fracture reduction and stabilization was 6.6 h. Consultants performed or supervised 90% of cases. Open reduction was necessary in 5% of cases. Complications included a perioperative nerve injury rate of 6% and a superficial pin site infection rate of 3%. This study suggests that, despite the challenge to trauma on-call rostering, the emergency management of these injuries is advantageous to patients in units of our size. Based on the data presented here we continue our practice of emergent management. We suggest that units of a similar size to our own would show a benefit from an analogous policy albeit an inconvenient truth.
authors.affiliation: Department of Orthopaedic Surgery, Waterford Regional Hospital, Dunmore road, Waterford, Ireland.
authors.forename: M
authors.initials: M
authors.lastname: Donnelly
authors.forename: C
authors.initials: C
authors.lastname: Green
authors.forename: I P
authors.initials: IP
authors.lastname: Kelly
mesh_terms: D000704:Analysis of Variance; D001858:Bone Nails; D001864:Bone Wires; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004551:Elbow Joint / Q000000981:diagnostic imaging; D004638:Emergency Treatment / Q000379:methods; D005260:Female; D005592:Fracture Fixation / Q000379:methods*; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods; D006801:Humans; D006810:Humeral Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D015601:Injury Severity Score; D004204:Joint Dislocations / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D010147:Pain Measurement; D011379:Prognosis; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology*; D020127:Recovery of Function; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome; D000092464:Elbow Injuries