|
Year |
2002 |
|---|---|
|
Question Number |
194. |
|
Category |
Pediatric Orthopaedics |
Question
A 5-year-old boy injured his right elbow after falling during a camping trip 8 hours ago. Exam reveals that the elbow is swollen, and there is a 1 cm laceration over the medial side with minimal seepage of serosanguinous fluid. The neurovascular exam is intact. Radiographs show a completely displaced supracondylar fracture of the right humerus. Surgery should be scheduled immediately because of the:
1. presence of an open fracture
2. need for traction if reduction is delayed
3. decreased ability to obtain a reduction
4. increased incidence of nerve palsy after delayed reduction
5. increased incidence of arterial injury after delayed reduction
Figures
Answer (click for answer)
Preferred Answer: 1
The standard treatment for displaced supracondylar humerus fractures in kids has been closed reduction and pinning. Often enough, this is done emergently. The rationale for emergent treatment has been to minimize swelling in an effort to decrease the risk of perioperative complications, such as compartment syndrome, infection, and nerve injuries, and to reduce the likelihood that conversion to an open reduction will be needed. The study cited addresses the question as to whether early (<8hrs) or delayed (>8hrs) operative treatment made a difference. This retrospective study found no significant difference in perioperative complications or difficulty with reduction between displaced supracondylar humeral fractures treated early versus delayed. Their study excluded the 2 scenarios that do prompt emergent surgical intervention: open fractures (which this child has) and the pulse less extremity.
Reference: Mehlam CT, Strub WM, Roy DR, Wall EJ, Crawford AH: The effect of surgical timing on perioperative complications of treatment of supracondylar humeral fractures in children. JBJS Am 2001;83:323-327.