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Closed reduction and stabilization of supracondylar fractures of the humerus in children: the crucial factor of surgical experience

Padman, Manoj; Warwick, Andrea M.; Fernandes, James A.; Flowers, Mark J.; Davies, Anthony G.; Bell, Michael J.

Journal of Pediatric Orthopaedics B: July 2010 - Volume 19 - Issue 4 - pp 298-303
doi: 10.1097/BPB.0b013e328333ab18
Upper Limb

We reviewed the outcome following operative management of displaced (Gartland II and III) supracondylar fractures of the humerus in children over a 2-year period and tried to correlate the outcome with various factors including experience of the treating surgeon. Of the 71 children who formed the study group, 62 (87.3%) had a good outcome irrespective of the treatment modality. Closed reduction followed by plaster immobilization or percutaneous pinning resulted in a better outcome than open reduction. There was a direct involvement of the consultant in the primary management of these injuries in 17 cases (24%), none of which had a poor outcome. Of the 54 cases in whom the primary management was carried out independently by trainees without any consultant supervision, nine patients (17%) developed complications or needed reoperations. The proportion of unsatisfactory outcomes increased to 20.3% when failure to achieve a satisfactory reduction by closed means was also considered as a perioperative complication. There is a learning curve associated with percutaneous pinning after closed reduction and experience of the surgeon seems to be one of the factors that have an influence on the outcome.

Department of Paediatric Orthopaedics and Trauma Surgery, Sheffield Children's Hospital, UK

Correspondence to James A. Fernandes, FRCS Tr & Orth, Consultant Orthopaedic Surgeon, Sheffield Children's NHS Trust, Western Bank, Sheffield S10 2TH, UK

Tel: +44 114 2717094; fax: +44 114 2267878;

e-mail: james.fernandes@sch.nhs.uk

© 2010 Lippincott Williams & Wilkins, Inc.