Pediatric Type II Supracondylar Humerus Fractures: Factors Associated With Successful Closed Reduction and Immobilization
| Autor: | Charles W. Wyatt, Philip L. Wilson, Lawson A B Copley, Patrick O. Ojeaga, Christine A. Ho, Henry B. Ellis |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
030222 orthopedics
business.industry Intraclass correlation Radiography medicine.medical_treatment Sedation Elbow General Medicine 03 medical and health sciences Percutaneous pinning 0302 clinical medicine medicine.anatomical_structure Pediatrics Perinatology and Child Health Fracture fixation medicine Orthopedics and Sports Medicine Humerus medicine.symptom business Nuclear medicine Reduction (orthopedic surgery) |
| Zdroj: | Journal of Pediatric Orthopaedics. 40:e690-e696 |
| ISSN: | 0271-6798 |
| Popis: | PURPOSE The debate on the treatment of type IIa supracondylar humerus fractures has yet to be resolved. The purpose of this study was to assess the factors associated with successful closed reduction and immobilization and to assess the efficacy of a novel radiographic "hourglass" angle measurement in the management of type IIa supracondylar humerus fractures within the pediatric population. METHODS An institutional review board-approved retrospective review of all children who underwent closed reduction and casting or splinting of an isolated type IIa supracondylar humerus fractures treated at 2 pediatric hospitals from January 1, 2009 to August 31, 2016. Analyzed radiographic parameters included Baumann angle (BA), humerocondylar angle (HCA), perpendicular distance (PD) from the anterior humeral line to the capitellum, and the hourglass angle (HGA). These parameters were measured on injury radiographs (XR), postreduction XR, and at the first and final follow-up XR. The success of closed reduction was defined as maintenance of an acceptable reduction without a secondary procedure. The interobserver reliability was calculated. RESULTS There were 77 elbows treated with closed reduction and long-arm cast or splint immobilization. Of those closed reductions, 76.62% of elbows (59/77) maintained their reduction alignment and did not require surgical treatment for percutaneous pinning. In this series, the BA was not significantly different following closed reduction ([INCREMENT]1.04 degrees; P=0.081); however, the PD ([INCREMENT]1.89 mm), HGA ([INCREMENT]7.38 degrees), and HCA ([INCREMENT]5.07 degrees) had significant improvement following closed reduction (P 0.9999), location of care-emergency department versus clinic (P=0.1160), or type of fracture immobilization (P=0.7411). The mean HGA in normal elbows was 177.8 degrees. The interobserver reliability for HCA was poor [intraclass correlation coefficient (ICC)=0.342]; fair for BA (ICC=0.458); and excellent for both PD and HGA (ICC=0.769 and 0.805, respectively) (P |
| Databáze: | OpenAIRE |
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