Presentation to the Emergency Department Increases the Likelihood of Surgical Management of Minimally Displaced Gartland Type IIa Pediatric Supracondylar Humerus Fractures.

Autor:	Groothoff JD; Wake Forest University School of Medicine., Kiritsis NR; Wake Forest University School of Medicine., Bullock GS; Wake Forest University School of Medicine.; Department of Orthopaedic Surgery and Rehabilitation, Atrium Health Wake Forest Baptist, Winston-Salem, NC., Frino J; Wake Forest University School of Medicine.; Department of Orthopaedic Surgery and Rehabilitation, Atrium Health Wake Forest Baptist, Winston-Salem, NC., Hughes MS; Wake Forest University School of Medicine.; Department of Orthopaedic Surgery and Rehabilitation, Atrium Health Wake Forest Baptist, Winston-Salem, NC., Mooney JF; Wake Forest University School of Medicine.; Department of Orthopaedic Surgery and Rehabilitation, Atrium Health Wake Forest Baptist, Winston-Salem, NC., Marquez-Lara A; Wake Forest University School of Medicine.; Department of Orthopaedic Surgery and Rehabilitation, Atrium Health Wake Forest Baptist, Winston-Salem, NC.
Jazyk:	angličtina
Zdroj:	Journal of pediatric orthopedics [J Pediatr Orthop] 2024 Sep 27. Date of Electronic Publication: 2024 Sep 27.
DOI:	10.1097/BPO.0000000000002833
Abstrakt:	Background: Few studies have explored factors influencing the clinical decision-making process in the management of Gartland type IIa supracondylar humerus fractures (SCHFs). This study sought to determine whether the location of patient presentation and patient socioeconomic status are associated with the treatment of type IIa SCHFs. Methods: This was a retrospective review of 262 patients younger than 13 years of age seen for acute Gartland type II SCHFs between 2012 and 2022. Pre-treatment radiographs were reviewed to measure Baumann angle and the location of the anterior humeral line relative to the capitellum. Demographic characteristics and socioeconomic status, measured through Child Opportunity Index (COI) scores, were generated and logistic regression analysis was performed to evaluate the relationship between location of presentation and fracture management. Logistic regressions were also used to evaluate the relationship between COI and location of presentation and treatment. Results: 137 male and 125 female patients met the inclusion criteria with a mean age of 5.95 (0.13) years at the time of presentation. Presentation to the emergency department (ED) demonstrated reduced odds of closed reduction and casting compared to outpatient clinic presentation [0.13 (95% CI: 0.02-0.98), P=0.048]. 27.5% of minimally displaced fractures that presented to the ED and 20.0% of minimally displaced fractures that presented to an outpatient clinic were treated surgically. There was no association between COI and the location of patient presentation [1.2 (95% CI: 0.9-1.5), P=0.226] or treatment received [1.04 (95% CI: 0.48-2.26), P=0.922]. Conclusion: These results suggest that patients who present to the ED after type IIa SCHFs are more likely to receive surgical treatment. COI does not appear to be associated with the location of presentation or treatment received. Level of Evidence: Prognostic level III. Competing Interests: The authors declare no conflicts of interest. (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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