title: Operative treatment of type II supracondylar humerus fractures: does time to surgery affect complications?
abstract: BACKGROUND
  Because of the changing referral patterns, operative pediatric supracondylar humerus fractures are increasingly being treated at tertiary referral centers. To expedite patient flow, type II fractures are sometimes pinned in a delayed manner. We sought to determine if delay in surgical treatment of modified Gartland type II supracondylar humerus fractures would affect the rate of complications following closed reduction and percutaneous pinning.
  
  
  METHODS
  We performed a retrospective review of a consecutive series of 399 modified Gartland type II supracondylar fractures treated operatively at a tertiary referral center over 4 years. Mean patient age in the type II group was 5 years (range, 1 to 15 y). A total of 48% were pinned within 24 hours, 52% pinned >24 hours after the injury.
  
  
  RESULTS
  No difference was in detected in rates of major complications between the early and delayed treatment group. Four percent of patients sustained a complication (16 patients). There were no compartment syndromes, vascular injuries, or permanent nerve injuries. Complications included nerve injury (3), physical therapy referral for stiffness (3), pin site infection (2 treated with oral antibiotics, 4 treated with debridement), refracture (2), and loss of fixation or broken hardware (2). Of the 3 patients who sustained nerve injuries, all underwent surgery within 24 hours of injury. One patient developed an ulnar motor and sensory nerve palsy after fixation with crossed K-wires. This resolved by 7 weeks postoperatively. Two patients presented with an anterior interosseous nerve palsy-1 resolved 1 week after surgery, the other by 8 weeks postoperatively.
  
  
  CONCLUSIONS
  Delay in surgery did not result in an increased rate of major complications following closed reduction and percutaneous pinning of type II supracondylar humerus fractures in children. Further prospective work is necessary to determine if there are subtle treatment benefits from emergent treatment of type II supracondylar humerus fractures.
  
  
  METHODS
  Level III-retrospective comparative series.
authors.affiliation: *Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN †Children's Hospital, Denver, CO ‡Department of Orthopedic Surgery, University of Texas Southwestern #Texas Scottish Rite Hospital for Children **Children's Medical Center, Texas Scottish Rite Hospital for Children, Dallas, TX §Department of Orthopedic Surgery, Emory University, Atlanta, GA ∥Department of Orthopedic Surgery, Brown University, Providence, RI ¶St. Christopher's Hospital for Children, Philadelphia, PA.
authors.forename: A Noelle
authors.initials: AN
authors.lastname: Larson
authors.forename: Sumeet
authors.initials: S
authors.lastname: Garg
authors.forename: Amanda
authors.initials: A
authors.lastname: Weller
authors.forename: Nicholas D
authors.initials: ND
authors.lastname: Fletcher
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Schiller
authors.forename: Michael
authors.initials: M
authors.lastname: Kwon
authors.forename: Richard
authors.initials: R
authors.lastname: Browne
authors.forename: Lawson A
authors.initials: LA
authors.lastname: Copley
authors.forename: Christine A
authors.initials: CA
authors.lastname: Ho
mesh_terms: D000293:Adolescent; D001858:Bone Nails; D001864:Bone Wires; D002648:Child; D002675:Child, Preschool; D003161:Compartment Syndromes / Q000453:epidemiology; D003646:Debridement; D005260:Female; D005500:Follow-Up Studies; D005594:Fracture Fixation, Intramedullary; D006801:Humans; D006810:Humeral Fractures / Q000601:surgery*; D006811:Humerus / Q000601:surgery; D007223:Infant; D008297:Male; D059348:Peripheral Nerve Injuries / Q000453:epidemiology; D026741:Physical Therapy Modalities; D011183:Postoperative Complications / Q000145:classification* / Q000453:epidemiology*; D057234:Preoperative Period; D011475:Prosthesis Failure; D012008:Recurrence; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000453:epidemiology; D062606:Tertiary Care Centers / Q000706:statistics & numerical data*; D013997:Time Factors; D016896:Treatment Outcome