title: Supracondylar humeral fractures in children: beware the medial spike.
abstract: Supracondylar humeral fractures are common in children, but there are no classification systems or radiological parameters that predict the likelihood of having to perform an open reduction. In a retrospective case-control study we evaluated the use of the medial spike angle and fracture tip-skin distance to predict the mode of reduction (closed or open) and the operating time in fractures with posterolateral displacement. A total of 21 patients (4.35%) with a small medial spike angle (< 45°) were identified from a total of 494 patients, and 42 patients with a medial spike angle of > 45° were randomly selected as controls. The medial spike group had significantly smaller fracture tip-skin distances (p < 0.001), longer operating times (p = 0.004) and more complications (p = 0.033) than the control group. There was no significant difference in the mode of reduction and a composite outcome measure. After adjustments for age and gender, only fracture tip-skin distance remained significantly associated with the operating time (β = -0.724, p = 0.042) and composite outcome (OR 0.863 (95% confidence interval 0.746 to 0.998); p = 0.048). Paediatric orthopaedic surgeons should have a lower threshold for open reduction when treating patients with a small medial spike angle and a small fracture tip-skin distance.
authors.affiliation: KK Women's & Children's Hospital, Division of Surgery, 100 Bukit Timah Road, 229899, Singapore. kevin.lim.BL@kkh.com.sg
authors.forename: K B L
authors.initials: KB
authors.lastname: Lim
authors.forename: C T
authors.initials: CT
authors.lastname: Lim
authors.forename: D K
authors.initials: DK
authors.lastname: Tawng
mesh_terms: D016022:Case-Control Studies; D002648:Child; D005260:Female; D005592:Fracture Fixation / Q000379:methods; D006801:Humans; D006810:Humeral Fractures / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D061646:Operative Time; D011183:Postoperative Complications / Q000517:prevention & control; D011300:Preoperative Care; D011859:Radiography; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome
keywords: Closed reduction; Elbow fracture; Fracture configuration; Paediatric; Pinning