Radiographic Evaluation of the Surgical Treatment of Pediatric Supracondylar Humeral Fractures

TL;DR

This study evaluates how well pediatric elbow fractures are fixed surgically, finding that poor reduction and timing of surgery affect outcomes.

Contribution

The study identifies technical errors and surgical timing as key factors in postoperative reduction loss in pediatric elbow fractures.

Findings

17% of cases had poor postoperative reduction.

48.7% of reduction loss cases had insufficient fixation.

Surgery performed at night or early morning had higher reduction loss (32%) compared to daytime (12.5%).

Abstract

Objective
 To perform a radiographic assessment of the quality of supracondylar fracture fixation by identifying the factors that have contributed to inadequate reduction and increased the chance of reduction loss during outpatient follow-up. The variables analyzed were as follows: fracture line, initial displacement, time of day the surgery was performed, and chosen fixation technique.

Methods
 Review of electronic medical records and radiographic evaluation of supracondylar fractures operated from January 2017 to December 2022. The radiograph assessment was based on the Baumann angle and the anterior humeral line. Determination of fixation quality was based on the number of cortices, crossing site, and wire divergence.

Results
 We evaluated 194 cases, and postoperative reduction was poor in 17% of the subjects. Reduction loss occurred in 39 cases (20.10%), and 19 (48.7%) of these patients presented insufficient fixation (
p
 = 0.002). Among the cases operated during the day, 12.5% lost the reduction compared with 32% of the patients who underwent surgery at night and early in the morning (
p
 = 0.001).

Conclusion
 Reduction quality and postoperative fixation loss were closely related to technical errors and the time of day the surgery was performed.

Objetivo
 Avaliar de forma radiográfica a qualidade da fixação das fraturas supracondilianas, identificando os fatores que contribuíram para uma redução inadequada e que aumentaram a chance de perda de redução no seguimento ambulatorial. As variáveis analisadas foram: traço de fratura, deslocamento inicial, período do dia em que a cirurgia foi realizada e técnica de fixação escolhida.

Métodos
 Revisão de prontuário eletrônico e avaliação radiográfica das fraturas supracondilianas operadas de janeiro de 2017 a dezembro de 2022. A avaliação das radiografias foi baseada no ângulo de Baumann e na linha umeral anterior. Já a qualidade de fixação foi mensurada pelo número de corticais, pelo local de cruzamento e pela divergência dos fios.

Resultados
 Foram avaliados 194 casos, sendo a redução pós-operatória considerada ruim em 17%. A perda de redução aconteceu em 39 casos (20,10%), sendo que 19 (48,7%) desses pacientes apresentaram fixação insuficiente (
p
 = 0,002). Dos casos operados durante o dia, 12,5% perderam a redução, comparados a 32% dos realizados nos períodos noturno e da madrugada (
p
 = 0,001).

Conclusão
 Dessa forma, a qualidade da redução e a perda da fixação pós-operatória mostraram-se intimamente relacionadas aos erros técnicos e ao período do dia em que a cirurgia foi realizada.

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