Gupta, J Pediatr Orthop 2004 - Effect of Surgical Delay on Perioperative Complications and Need for Open Reduction in Supracondylar Humerus Fractures in Children
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Effect of Surgical Delay on Perioperative Complications and Need for Open Reduction in Supracondylar Humerus Fractures in Children
Gupta, Skaggs, et al.·J Pediatr Orthop·2004·196 citations
Gupta and colleagues asked whether waiting more than 12 hours to operate on a pediatric supracondylar humerus fracture raises perioperative complications or the need for open reduction.
Retrospective review of 150 consecutive children treated operatively by four surgeons at Children's Hospital Los Angeles, January 2000 to June 2001.
Key Findings
Delay beyond 12 hours showed no significant increase in open reduction, nerve or vascular injury, or pin tract infection, for all fractures or for type III alone.
The study had 7% power to detect a 20% relative difference in complications. The authors estimate about 6900 patients would have been needed.
Open reduction was needed in 2 of 150 (1.3%), both delayed type III fractures (2 of 34, 6%, vs 0 of 35 early, p = 0.24). The authors say the numbers are too small for a valid conclusion.
No child developed compartment syndrome or iatrogenic nerve injury, and no fracture lost reduction. One delayed patient had a pin tract infection treated with oral antibiotics.
All but 1 of 150 fractures were pinned from the lateral side only. The authors credit this for the absence of iatrogenic nerve injury.
Most delays came from transfers rather than surgeon choice, but the worst fractures may have gone to early surgery. Children with vascular deficits were excluded, so the findings do not apply to them.
Board pearl
No difference after 12‑hour delay is not proof of safety: with 7% power, a real increase in complications could easily be missed. The authors leave urgency to surgeon judgment when soft tissues are at risk.
Authors' conclusion
We found that a delay in the operative treatment of isolated supracondylar humerus fractures in children without significant soft tissue or vascular injury did not significantly increase the rate of open reduction or compromise the perioperative risks examined.
Gupta and colleagues asked whether waiting more than 12 hours to operate on a pediatric supracondylar humerus fracture raises perioperative complications or the need for open reduction.
Retrospective review of 150 consecutive children treated operatively by four surgeons at Children's Hospital Los Angeles, January 2000 to June 2001.
Key Findings
Delay beyond 12 hours showed no significant increase in open reduction, nerve or vascular injury, or pin tract infection, for all fractures or for type III alone.
The study had 7% power to detect a 20% relative difference in complications. The authors estimate about 6900 patients would have been needed.
Open reduction was needed in 2 of 150 (1.3%), both delayed type III fractures (2 of 34, 6%, vs 0 of 35 early, p = 0.24). The authors say the numbers are too small for a valid conclusion.
No child developed compartment syndrome or iatrogenic nerve injury, and no fracture lost reduction. One delayed patient had a pin tract infection treated with oral antibiotics.
All but 1 of 150 fractures were pinned from the lateral side only. The authors credit this for the absence of iatrogenic nerve injury.
Most delays came from transfers rather than surgeon choice, but the worst fractures may have gone to early surgery. Children with vascular deficits were excluded, so the findings do not apply to them.
Board pearl
No difference after 12‑hour delay is not proof of safety: with 7% power, a real increase in complications could easily be missed. The authors leave urgency to surgeon judgment when soft tissues are at risk.
Authors' conclusion
We found that a delay in the operative treatment of isolated supracondylar humerus fractures in children without significant soft tissue or vascular injury did not significantly increase the rate of open reduction or compromise the perioperative risks examined.