title: The epidemiology of paediatric supracondylar fracture fixation: a population-based study.
abstract: BACKGROUND
  The epidemiology of paediatric supracondylar fracture (SCF) fixation has not been evaluated at a population level. The purpose of this study was to: (1) determine the incidence density rate (IDR) of SCF fixation and (2) determine the rate of and risk factors for re-operation.
  
  
  METHODS
  Using administrative databases, all patients who underwent SCF fixation (closed reduction percutaneous pinning (CRPP) or open reduction (OR)) in Ontario between April 2002 and March 2010 were identified. Exclusion criteria included age (>12 years), a prior or concurrent non-SCF elbow fracture or previous humeral osteotomy. The overall IDR of SCF fixation and for subgroups of age, sex and season were calculated. A multivariate regression (immediate and short-term re-operation) and a Cox proportional hazards model (long-term re-operation) were used to identify patient, injury and provider factors that influenced re-operation risk and were reported as odds ratios or hazard ratios (HRs) with 95% confidence intervals (CIs), respectively.
  
  
  RESULTS
  A total of 3235 patients with a median age of 6.0 years (interquartile range (IQR): 3.0) underwent SCF fixation. The median follow-up was 6.0 years (IQR: 3.7). The majority underwent a CRPP (78.7%) which were performed after hours (75.6%). The overall IDR was 20.7/100,000 person-years (py), but it varied significantly by season and age. Re-operation was uncommon in the immediate (1.0%), short-term (1.4%) and long-term (0.3%) follow-up period. As compared to CRPP, patients who underwent OR were more likely to undergo early nerve exploration (odds ratio: 7.8 (CI: 3.0-20.6)) and re-operation in the long term (HR: 3.0 (CI: 1.0-8.7)). Increased surgeon volume of SCF fixation was protective against repeat fixation (odds ratio: 0.9 (CI: 0.9-1.0)) and re-operation in the long term (HR: 0.9 (CI: 0.8-1.0)).
  
  
  CONCLUSIONS
  While SCF fixation is common, the rate of re-operation is low. No differences existed between the sexes and a higher volume of fixations occurred during the summer months.
authors.affiliation: University of Toronto, Division of Orthopaedic Surgery, Toronto, ON, Canada; The Hospital for Sick Children, Division of Orthopaedic Surgery, Toronto, ON, Canada. Electronic address: amir.khoshbin@mail.utoronto.ca.
authors.forename: Amir
authors.initials: A
authors.lastname: Khoshbin
authors.affiliation: University of Toronto, Division of Orthopaedic Surgery, Toronto, ON, Canada.
authors.forename: Timothy
authors.initials: T
authors.lastname: Leroux
authors.affiliation: University of Toronto, Division of Orthopaedic Surgery, Toronto, ON, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Wasserstein
authors.affiliation: University of Toronto, Division of Orthopaedic Surgery, Toronto, ON, Canada.
authors.forename: Jesse
authors.initials: J
authors.lastname: Wolfstadt
authors.affiliation: The Hospital for Sick Children, Division of Orthopaedic Surgery, Toronto, ON, Canada.
authors.forename: Peggy W
authors.initials: PW
authors.lastname: Law
authors.affiliation: University of Toronto, Division of Orthopaedic Surgery, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.
authors.forename: Nizar
authors.initials: N
authors.lastname: Mahomed
authors.affiliation: University of Toronto, Division of Orthopaedic Surgery, Toronto, ON, Canada; The Hospital for Sick Children, Division of Orthopaedic Surgery, Toronto, ON, Canada.
authors.forename: James G
authors.initials: JG
authors.lastname: Wright
mesh_terms: D002170:Canada / Q000453:epidemiology; D002370:Casts, Surgical; D002648:Child; D002675:Child, Preschool; D005260:Female; D005593:Fracture Fixation, Internal; D017102:Fracture Healing; D006801:Humans; D006810:Humeral Fractures / Q000453:epidemiology* / Q000503:physiopathology / Q000601:surgery; D007103:Immobilization / Q000379:methods*; D007223:Infant; D015601:Injury Severity Score; D008297:Male; D016017:Odds Ratio; D012086:Reoperation / Q000706:statistics & numerical data; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome
keywords: Complications; Humerus; Paediatric; Population; Supracondylar fractures