Clinical and Radiographic Outcomes of Supracondylar Humerus Fractures Treated Surgically by Pediatric and Non-Pediatric Orthopaedic Surgeons

Eamonn Mahoney M.D., Monique Grey M.D., Peter DeLuca M.D.,

 Seth Dodds M.D.,                  

One of the most common pediatric fractures requiring surgery is the supracondylar humerus fracture.  Complications of the surgical treatment of these fractures have been reported, with a 0-11% rate of iatrogenic nerve injury and a 0-13% rate of malunion and deformity reported in the current literature.^1-17

A review of supracondylar humerus fractures treated in New England from 1991-1999 demonstrated a change in treatment patterns over that nine-year period, with 63% of fractures being treated by general orthopaedic surgeons in 1991 compared with 32% in 1999.    The purpose of this study is to determine if there is a difference in the complication rates of supracondylar humerus fractures treated operatively by pediatric and non-pediatric orthopaedic surgeons over a twelve-year period at a single institution. 

The study design was a single-center retrospective review.   .  A computerized medical records search was conducted to identify all children with operatively treated supracondylar humerus fractures between January 1, 1994 and March 1, 2007 at Yale-New Haven Hospital.  The inclusion criteria were skeletal immaturity, age under 13, surgical treatment of a supracondylar humerus fracture, a minimum of one month of clinical follow-up and two weeks of radiographic follow-up, documentation of pre- and postoperative neurovascular examination, documentation of range of motion at the time of final follow-up, and adequate immediate postoperative and follow-up radiographs.    In all 306 patients were identified and 146 met the inclusion criteria.  Radiographs were reviewed by two attending surgeons, one hand and the other pediatric fellowship trained.   Quality of reduction, fixation and finally results both clinical and radiographical were evaluated. 

This study found no significant difference in the rates of clinical complications in children with supracondylar humerus fractures treated surgically by pediatric and non-pediatric orthopaedic surgeons.  There was a significantly higher incidence of open reduction and inadequate fracture fixation in children treated by non-pediatric orthopaedic surgeons, but neither variable had a significant correlation with the attainment of functional  motion or loss of fracture reduction, respectively.