O3254: Safety of Semi-Elective Treatment of Supracondylar Fractures of the Humerus in the Pediatric and Adolescent Populations

Background: Supracondylar fractures (SCFs) of the humerus are the most common type of elbow fracture among children. These fractures are traditionally treated emergently to reduce the risk of complications including increased pain, swelling, compartment syndrome, and neurovascular injury. The purpose of this study is to assess the effect of time to treatment on subsequent outcomes of SCFs within the pediatric and adolescent populations.

Methods: A retrospective review was performed to identify patients 0-17 years of age who underwent closed reduction and percutaneous pinning for a supracondylar fracture of the humerus. Those fractures treated within 24 hours were considered the emergent group and those treated in greater than 24 hours were considered the semi-elective group. Data collected included patient demographics, fracture classification, number of pins utilized, pin configuration, timing to surgery, post operative immobilization, outcomes, and complications. Simple statistical analysis was performed.

Results: 227 patients with an average age of 5.2 years were identified. 120 (52.9%) patients underwent semi-elective treatment with a median time to surgery of 120 hours (IQR: 72 hours-192 hours). 107 (47.1%) patients underwent emergent treatment with a median time to surgery of 16 hours (IQR: 12.25 hours-18 hours). Gartland Type III fractures occurred at a higher rate within the emergent group (55.1% vs. 2.5%; p< 0.001), whereas the semi-elective group had a higher rate of Gartland Type II fractures (85.8% vs. 25.2%; p< 0.001). The semi-elective group more commonly utilized 2 (38.3% vs. 11.2%; P< 0.001) pins for fixation. The emergent group more commonly utilized either 3 (69.1% vs. 55.0%; p=0.02) or 4 (18.7% vs. 5.0%; p=0.001) pins for fixation. Fractures treated emergently had a higher rate of complication (24.3% vs. 13.4%; p=0.03). Complications within the emergent group included nerve palsy (n=14), decreased range of motion (ROM) (n=6), malunion requiring additional surgery (n=2), post operative angular deformity (n=1), infection (n=1), pin migration (n=1), and subsequent refracture (n=1). Complications within the semi-elective group included decreased ROM (n=10), infection (n=2), nerve palsy (n=2), and malunion requiring additional surgery (n=2). There were no statistically significant differences between groups with respect to pin configuration, post-operative immobilization, time to pin removal, or time to union.

Conclusion: Pediatric and adolescent Gartland Type II SCFs can usually be operatively managed with CRPP semi-electively (>24 hours) with similar outcomes to emergent/urgent intervention. Gartland Type III fractures should continue to receive emergent/urgent intervention when appropriate. Surgeons should continue to utilize clinical judgement to determine timing of operative intervention of pediatric and adolescent SCFs to limit any potential complications.