Supracondylar Elbow Fractures Research Articles

Incidence of complications among operative pediatric supracondylar humerus fractures using medial and lateral pins: a safe technique for percutaneous medial pin placement.

Cross-pinning of displaced pediatric supracondylar elbow fractures offers a superior stability construct. However, there is a reluctance to use this construct by closed means because of the risk of iatrogenic ulnar nerve injuries associated with percutaneous medial pin placement. This study describes a safe technique for closed reduction percutaneous with medial pin placement. This study reviewed the clinical charts of 232 pediatric patients who underwent closed reduction with cross-pinning of Gartland type II and III supracondylar fractures from 2000 to 2022 at a single institution. All surgeries were performed by the same attending surgeon at the same institution, with the same technique of medial pin placement. The inpatient and outpatient notes were used to record patient demographic information, fracture classification, and postoperative complications. A total of 232 pediatric patients [114 boys, 118 girls; mean age: 5.8 (range: 1-14) years] with Gartland type II (n = 97) and III (n = 135) supracondylar fractures were included in the study. There were a total of seven (3.02%) postoperative complications: four (1.7%) ulnar neuropathies, two (0.86%) pin site infections, and one (0.43%) anterior interosseous nerve palsy. All documented postoperative complications were resolved by the 3-month follow-up visit. There were no complications of deep infection, malunion, or nonunion. With the proper technique, closed reduction with percutaneous medial pin fixation of pediatric supracondylar fractures is safe and produces excellent postoperative outcomes. Level of Evidence: Level IV, case series.

The Impact of Supratrochlear Foramen on Humeri's Medullary Canal Diameter and Its Surgical Implications.

Introduction Supracondylar elbow fractures are prevalent in the pediatric age group, and retrograde intramedullary nailing of the humerus is a common treatment approach. The anatomy of the medullary canal and the presence of the supratrochlear foramen (STF) significantly influence the stabilization of the nail. This study aimed to determine the incidence and morphology of the STF and compare the width of the medullary canal in humeri with and without the STF. Methods We examined 40 humeri bones with fused humeral epiphyses for the presence of the STF obtained from the Department of Anatomy's osteology collections. We studied the morphology and measured the dimensions of the foramen. We then compared the morphometric characteristics of humeri bearing the STF with those without it. We also took radiographs of all bones and measured the medullary canal width at three levels. We compared the measured width of the medullary canal in humeri between those with an STF and those without. This analysis was performed using IBM SPSS Statistics version 27.0 (Armonk, NY: IBM Corp.) for Windows and an unpaired t-test. We considered p-values of less than 0.05 as statistically significant. Results We found the STF in six bones (15%) as follows: four on the left side and two on the right. Humeri with the STF had smaller mean head circumference, length, and shaft circumference than those without the foramen. However, this difference was not statistically significant (p>0.05). The mean width of the medullary canal in humeri with the STF was significantly smaller (p<0.05) than in bones without the STF. Conclusions Our study revealed that humeri with an STF present a significantly smaller diameter of the medullary canal, which can impact surgical procedures like retrograde intramedullary nailing. Clinicians should consider this when planning surgeries to avoid iatrogenic fractures and enhance procedural efficiency. Our data also suggest that larger humeri are less likely to have an STF, potentially influencing pre-surgical planning and fracture risk assessment.

Children’s orthopaedics

The April 2023 Children’s orthopaedics Roundup360 looks at: Can you treat type IIA supracondylar humerus fractures conservatively?; Bone bruising and anterior cruciate ligament injury in paediatrics; Participation and motor abilities after treatment with the Ponseti method; Does fellowship training help with paediatric supracondylar fractures?; Supracondylar elbow fracture management (Supra Man): a national trainee collaborative evaluation of practice; Magnetically controlled growing rods in early-onset scoliosis; Weightbearing restrictions and weight gain in children with Perthes’ disease?; Injuries and child abuse increase during the pandemic over 12,942 emergency admissions.

Supracondylar elbow fracture management (Supra Man)

Management of displaced paediatric supracondylar elbow fractures remains widely debated and actual practice is unclear. This national trainee collaboration aimed to evaluate surgical and postoperative management of these injuries across the UK. This study was led by the South West Orthopaedic Research Division (SWORD) and performed by the Supra Man Collaborative. Displaced paediatric supracondylar elbow fractures undergoing surgery between 1 January 2019 and 31 December 2019 were retrospectively identified and their anonymized data were collected via Research Electronic Data Capture (REDCap). A total of 972 patients were identified across 41 hospitals. Mean age at injury was 6.3 years (1 to 15), 504 were male (52%), 583 involved the left side (60%), and 538 were Gartland type 3 fractures (55%). Median time from injury to theatre was 16 hours (interquartile range (IQR) 6.6 to 22), 300 patients (31%) underwent surgery on the day of injury, and 91 (9%) underwent surgery between 10:00 pm and 8:00 am. Overall, 910 patients (94%) had Kirschner (K)-wire) fixation and these were left percutaneous in 869 (95%), while 62 patients (6%) had manipulation under anaesthetic (MUA) and casting. Crossed K-wire configuration was used as fixation in 544 cases (59.5%). Overall, 208 of the fixation cases (61%) performed or supervised by a paediatric orthopaedic consultant underwent lateral-only fixation, whereas 153 (27%) of the fixation cases performed or supervised by a non-paediatric orthopaedic consultant used lateral-only fixation. In total, 129 percutaneous wires (16%) were removed in theatre. Of the 341 percutaneous wire fixations performed or supervised by a paediatric orthopaedic consultant, 11 (3%) underwent wire removal in theatre, whereas 118 (22%) of the 528 percutaneous wire fixation cases performed or supervised by a non-paediatric orthopaedic consultant underwent wire removal in theatre. Four MUA patients (6%) and seven K-wire fixation patients (0.8%) required revision surgery within 30 days for displacement. The treatment of supracondylar elbow fractures in children varies across the UK. Patient cases where a paediatric orthopaedic consultant was involved had an increased tendency for lateral only K-wire fixation and for wire removal in clinic. Low rates of displacement requiring revision surgery were identified in all fixation configurations.Cite this article: Bone Joint J2023;105-B(1):82-87.

Supracondylar Displaced Fracture of Elbow in Children Treated with Closed Reduction and Percutaneous K Wire Fixation

Objective: To compare the closed reduction and percutaneous K wire fixation method outcomes in the treatment of supracondylar displaced fracture of elbow in children. Study Design: Prospective study Place and Duration of Study: Department of Orthopaedics, Arif Memorial Teaching Hospital, Lahore from 2nd April 2021 to 31st September 2021. Methodology: One hundred and seventy children were included. Those children having supracondylar displaced fractures of elbow with a grade 3 were included in the study as participant. K wires of 1.5-2cm were used after closed reductions were satisfactorily achieved. Padded-Back slabs at posterior position of elbow were applied. At 2 weeks’ suture removal and pin configuration was also observed. Callus production was observed through radiological x ray images. Results: Majority of the children belonged to the age group of 6-10 years. There were 59.4% males while 40.58% were females. Within the total number of cases 55% were administered two lateral parallel K wires while 45% were administered cross K wire. Pin tract infection was formed in 2.5% of lateral K wire cases while it was observed in only 1.2 % of Cross wire cases. Most of the children got the fracture while playing a sport. The recovery phase was of 3.5 months while fracture joined in a mean value of 1 month. Conclusion: Lateral percutaneous pin technique for the management of supracondylar fracture of humerus bone is a more suitable method and offers same results without involvement of iatrogenic ulnar nerve injury. Keywords: Humerus, Ulnar nerve, Pin method, K-wire, Deformation

Outcomes of Percutaneous Cross K-Wire Fixation for the Management of Supracondylar Displaced Fractures of Elbow in Children

Background: It is estimated that about 16–17 percent of all fractures in pediatric patients are supra-condylar fractures of the elbow. Different techniques are used for the management of supracondylar displaced fractures of elbow in children. Objective: To find out the outcomes of percutaneous cross- K-wire fixation for the management of supracondylar displaced fractures of elbow in children Methodology: This descriptive cross sectional study was carried out at Orthopedic Department of Khyber Teaching Hospital Peshawar for duration of one year from June 2021 to July 2022. A total of 80 patients were included in the current study. All the patients were followed for up to six months. At last follow-up, all patients were evaluated using Flynn's criteria. All the data analysis was done by using IBM SPSS version 23. Results: On the basis of Flynn’s criteria, excellent results were observed in 54 (67.5%) patients, good results in 20 (25%) patients, fair results in 4 (5%) patients while poor results were observed in 2 (2.5%). Based on the post-operative associated problems, pin-tract infections were observed in 7 (8.75%) patients, cubitus varus deformity was observed in 2 (2.5%) and temporary ulnar nerve deficit was observed in 5 (6.25%) patients. Conclusion: Our study concludes that in children, type-II &amp; III supra-condylar displaced fracture of elbow can be managed easily and effectively with a low rate of complications. Keywords: Percutaneous cross- K-wire fixation; Supracondylar displaced fractures; Elbow

Comparison of Lateral and Crossed K-wires for Paediatric Supracondylar Fractures: A Retrospective Cohort Study.

BackgroundSupracondylar elbow fractures occur most frequently in children aged five to seven years and have equal incidence in both genders. They are classified as flexion or extension type injuries with extension type being more common. We aimed to ascertain radiological stability with lateral and crossed wires in this study. We also identified any complications after operative management of these injuries.MethodsAs part of this retrospective cohort study, we identified all patients who presented with this injury from January 1, 2020, until February 28, 2022. Basic demographic data and type of operation were noted. Baumann angle (BA) and lateral capitellohumeral angle (LCHA) were measured intra-operatively and x-rays were done at the final clinic appointment. The mean of these angles in lateral and crossed wire groups was compared using paired sample t-test. Unpaired t-test was used to compare the means of both groups with normal values for these angles based on previous studies (BA=71.5±6.2 degrees, LCHA= 50.8±6 degrees).ResultsFifty patients were admitted during this period. Thirty-three patients had lateral wires and 17 had crossed wires for fixation. No significant change was noted in the mean BA and mean LCHA in both groups on x-rays done intra-operatively and final clinic follow-up (no loss of reduction). No significant difference was noted between BA and LCHA noted for both groups at the final clinic follow-up with previous studies outlining normal values for these angles. No cases of iatrogenic neurovascular injury were identified. Four patients (8%) were referred to physiotherapy due to stiffness.ConclusionBoth lateral and crossed wire configurations led to achievement of good radiological stability with BA and LCHA within normal limits. No loss of reduction was noted with both techniques and no risk of iatrogenic nerve injuries was noted in experienced hands.

Interventions for treating supracondylar elbow fractures in children.

Interventions for treating supracondylar elbow fractures in children.

Incidence of flexion-type supracondylar fractures at a single Australian level one Paediatric Trauma Centre.

BackgroundSupracondylar fractures are the most common elbow fracture. There have been no studies published analysing flexion‐type fractures in the Australian paediatric population. This paper aims to investigate flexion‐type supracondylar fractures in an Australian paediatric population. Eight hundred and three paediatric supracondylar elbow fractures were retrospectively reviewed at one hospital over a 5 year time period. The focus was on flexion‐type fractures.MethodsSupracondylar fractures that presented to the Women's and Children's Hospital Emergency Department between 2015 and 2020 were retrospectively reviewed. Fractures were classified on plain radiographs according to the Modified Gartland Classification System. Injury and treatment data were collected for flexion‐type fractures.ResultsTwenty‐one (2.6%) of fractures were flexion‐type. The average age of injury was 6.8 years old. Flexion‐type fractures were more common in females (62%) and with high energy mechanisms (81%). Ulnar nerve palsies occurred in five cases (24%). Two ulna nerve palsies did completely resolve at 3 months follow up. One open fracture occurred. No vascular injuries occurred. Ten of the 21 flexion‐type fractures (48%) were treated surgically.ConclusionsThe authors conclude that: flexion fractures are uncommon, they occur more often after high energy mechanisms such as falls from monkey bars, swings, or trampolines. Flexion‐type fractures occur more often in slightly older females. The ulnar nerve is most frequently injured and in the current study—exclusively injured. At 3 month follow up, spontaneous nerve recovery had occurred in three of the five cases (60%).

Management of acute paediatric fractures treated surgically in the UK: a cross-sectional study.

The epidemiology of acute paediatric orthopaedic trauma managed surgically across the NHS is poorly described. Compliance against national standards for the management of supracondylar humeral fractures is also unknown at a national level. Collaborators in 129 NHS hospitals prospectively collected data on surgically managed acute paediatric orthopaedic trauma cases. Data were collected over a seven-day period and included demographics, injury characteristics, operative details and timing of surgery. A national audit was also undertaken to evaluate compliance with the British Orthopaedic Association Standards for Trauma Guideline 11: Supracondylar Fractures of the Humerus in Children. Data were captured on 770 surgically treated cases. The three most common injuries were forearm fractures of both bones (n = 235), distal radius fractures (n = 194) and supracondylar elbow fractures (n = 89). The mode day of injury was Friday (n = 136) and the mode day of surgery was Saturday (n = 138). 88% of supracondylar fractures received surgery on the day of presentation or the following day. Only 14% of supracondylar fractures were treated surgically after 8pm; 33/89 used 2.0mm Kirschner wires, 38/89 used 1.6mm wires and 2/89 used 1.2mm wires. Forearm fractures of both bones, distal radius fractures and supracondylar humeral fractures were the three most common injuries treated surgically. There is wide variation in compliance against national standards in the management of supracondylar humeral fractures with 88% undertaking surgery on the day of or the day following presentation but only 37% using the recommended 2.0mm Kirschner wires.

Interventions for treating supracondylar elbow fractures in children

Interventions for treating supracondylar elbow fractures in children

Epidemiological Analysis of Displaced Supracondylar Fractures.

Introduction: Supracondylar fractures are one of the most common fracture patterns sustained by children, and one of the most common injuries requiring operative fixation. Understanding the complications associated with supracondylar fractures is vital for the practicing orthopedic surgeon. This analysis of supracondylar fractures examined the clinically important aspects including vascular injury, compartment syndrome, neurological injury, brachialis entrapment, associated injuries, and etiologies of injury. Recent advances in technology have resulted in a myriad of new forms of recreational equipment for children to play with. The purpose of this study is to compare the historical literature, the current literature, and a single surgeon’s sample of supracondylar fractures. In addition, this study aims to evaluate if any changes in epidemiology or etiology have occurred due to the development of new recreational equipment.Objective: The purpose of this study is to evaluate and provide a qualitative overview of the epidemiology of displaced supracondylar fractures, to compare historically reported numbers to more recent literature as well as a single surgeon sample, and to evaluate if changes in epidemiology or etiology have occurred due to the new recreational equipment that children use.Methods: Some 75 displaced supracondylar elbow fractures were reviewed. Data elements recorded from the electronic medical record (EMR) included patient age, gender, height, weight, handedness, date, time, location, mechanism, Gartland classification, concurrent injuries, and neurovascular status. Results: In this study, there were 42 males and 33 females. The average age was six years. Some 70 of the 75 patients were older than the age three. One fracture was open, nine fractures had a pucker sign, seven presented with a nerve palsy, four presented without a pulse, and seven patients presented with an additional ipsilateral distal radius fracture. All fractures were the result of a fall. Falls from playground equipment resulted in 29 fractures. There were 10 from falls off of furniture, six from falls during sports, three from falls on the stairs, and three from fall off of bikes. The remaining fractures resulted from running, tripping, falling from a toy ball, sled, tree, wagon, fence, bounce house, van, deck, power wheels car, ATV, and a go-cart.Some 64 fractures were transferred from 27 different outside hospitals. Eleven fractures presented directly to the ED. Twenty-six fractures occurred during the summer, 20 occurred in the autumn, 6 occurred in the winter, and 23 occurred during the spring. Some 35 fractures occurred at home, 30 on the school grounds, four in a gymnasium, four in a park, one at a farm show, and one in a parking lot. Some 25 fractures were treated between midnight and 8 am, 16 were treated between 8 am and 5 pm, and 34 were treated between 5 pm and midnight. Conclusion: Pediatric supracondylar fractures are common in children, and many of them require operative intervention. This study examined the most important aspects of supracondylar fractures. This update provides a look at the clinically important aspects of supracondylar fractures and compares them to previous teachings and canon. Despite the advancement and changes in recreational equipment that children are using, children are still sustaining supracondylar fractures in the most common ways including falls from playground equipment and falls from standing.

AB129. Opioid use following closed reduction and percutaneous pinning of paediatric supracondylar elbow fractures is not required to achieve adequate pain relief

AB129. Opioid use following closed reduction and percutaneous pinning of paediatric supracondylar elbow fractures is not required to achieve adequate pain relief

Outcome of Delayed Treatment of Supracondylar Elbow Fractures in Children in Hasan Sadikin Hospital Bandung and Santosa Hospital Bandung

Objectives:Supracondylar fractures of the elbow are common in children and percutaneous pinning usually advocated as a treatment for this kind of fracture. However, the treatment is often delayed in areas where healthcare resources are limited. The objective of this retrospective study was to assess functional outcomes after delayed treatment of supracondylar elbow fractures in children.Methods:We retrospectively reviewed the medical charts of 38 children aged 2 to 15 years in whom surgery for extension-type supracondylar elbow fractures was delayed by more than 1 week. The 22 boys and 16 girls with a mean age of 5 years 3 months had severe fracture displacement (12 stages III and 26 stage IV according to Lagrange and Rigault classification scheme). The mean time to treatment was 7 days (range: 1-4 weeks). Open reduction and crossed K-wire fixation via the posterior approach were performed in all patients. Functional outcomes were evaluated using Flynn’s criteria.Results:Outcomes were satisfactory in 31 (81,5%) of patients. At last follow-up after a mean of 3 months, three (7,8%) patients had limited in elbow motion. No case of compartment syndrome, surgical site infection and re-operation.Conclusion:Despite an average time to surgery of 16 days, the outcome was satisfactory in (81,5%) of cases. Delayed treatment was not associated with an increased rate of postoperative complications.

Role of the Posterior Fat Pad Sign in Treating Displaced Extension Type Supracondylar Fractures of the Pediatric Elbow Using the Blount Method.

The posterior fat pad sign (PFPS) on the lateral elbow X-ray is useful in the diagnosis of a suspected nondisplaced fracture about the elbow after a subtle injury. However, the presence of a PFPS hallmarks a continuous posterior periosteum-posterior capsule of the distal humerus. This anatomic structure is crucial for the stable anatomic reduction of a displaced extension type supracondylar fracture. Subsequently, the presence of a PFPS may predict the successful nonoperative treatment of a Gartland III-type fracture by means of the Blount method, implying less implant-related morbidity and less intraoperative radiation exposure for the patient and surgeon. Furthermore, it is concluded that a PFPS-positive displaced extension type supracondylar fracture is definitively classified as a Gartland III and not a Gartland IV-type fracture. A retrospective study of 75 displaced extension type supracondylar elbow fractures was performed. All fractures had an initial attempt at a closed reduction under general anesthesia. A stable reduction in 120 degrees of elbow flexion without vascular compromise of the affected limb was achieved in 45 fractures, which were splinted in this position. In the remaining 30 cases, fracture reduction was either inadequate or was achieved with excess elbow flexion, which impaired distal blood flow. These fractures were pinned percutaneously and splinted in 90 degrees of elbow flexion. The two treatment groups were retrospectively compared for the presence of a PFPS. The displaced extension type supracondylar fractures, which were treated successfully by the Blount method, had a statistically significant higher prevalence (chi-square-Yates =4.91, p<0.05) of a positive PFPS (28/45 patients, 62.22%) compared to the fractures treated by closed reduction and percutaneous pinning (10/30, 33.33%). No vascular complications were observed. The long-term outcome did not differ between groups.

Diagnostic accuracy of the shaft-condylar angle for an incomplete supracondylar fracture of elbow in children.

The incomplete supracondylar fracture of distal humerus poses difficulty for diagnosis. A shaft-condylar angle and a lateral capitellohumeral angle, which can be measured from a routine lateral view of plain film of the injured elbow, may be a clue to assist in the diagnosis. Nevertheless, no literature explains about the accuracy of these angles for diagnosis. Our goal is to investigate the accuracy, sensitivity, specificity, positive predictive value and negative predictive value of the shaft-condylar angle and the lateral capitellohumeral angle for diagnosis of the incomplete supracondylar fracture. The retrospective study in tertiary care hospital was performed from January, 2014, to January, 2018. The patients aged below 15years with elbow injury were recruited. The patients with complete fracture were excluded. The rest of the patients were divided into four groups which consisted of incomplete fracture and non-fracture group. With the shaft-condylar angle at 40° and the lateral capitellohumeral angle at 50°, the diagnostic accuracy of both angles were calculated. A total number of patients were 53. For the SCA, the accuracy was 92%, the sensitivity was 76%, the specificity was 93%, the positive predictive value was 92% and the negative predictive value was 93%. For the LCHA, the accuracy was 70%, the sensitivity was 55%, the specificity was 72%, the positive predictive value was 67% and a negative predictive value was 72%. The shaft-condylar angle less than 40° in lateral elbow film might be a useful tool for diagnosis of the incomplete supracondylar fracture in pediatric patients with elbow injury.

Assessment of interpretation of paediatric skeletal radiographs in the emergency room

To assess the performance of paediatric skeletal radiography interpretation in the emergency department. In a large paediatric referral centre, data from trauma patients with initially misdiagnosed skeletal radiography was collected from October 2014 to June 2015. Data analysis focused on demographic data, region of the injury and clinical consequences as well as outcome of treatment. In 125 of 2,316 patients aged from 1-17 years an initial misdiagnosis was documented (5.4%). Misdiagnosis was detected and corrected the next day in a routine review attended by an experienced paediatric radiologist. False-negative interpretation (missed fracture) was found in 62 and false-positive (overdiagnosis) interpretation in 63 patients. The highest error rate was found in elbow radiography (12%) followed by wrist (8%), fingers (4.5%), metacarpus (4.2%), and toes (3.5%). The most frequently missed fracture was supracondylar elbow fracture (n=12). In case of initially missed fractures treatment was adjusted delayed the next day. In none of these patients, were repositioning or open surgical procedures necessary. No misdiagnosis resulted in additional morbidity. Misinterpretation of paediatric skeletal radiography by paediatric emergency physicians occurred frequently. The majority of diagnostic errors occurred in a few regions. None of these misdiagnoses negatively affected patients' health. A routine review by an experienced paediatric radiologist is mandatory, but may suffice the next day.

A clinical study of closed reduction and crossed percutaneous pinning of supracondylar fracture of elbow in children

Introduction: Closed reduction and crossed percutaneous pinning under high quality fluoroscopic imaging is a reliable technique for obtaining and maintaining near anatomical reduction of supracondylar fractures of humerus in children, preserving vascular function. There is greater stability or ability to maintain reduction with the crossed pinning technique. The primary risk of injury to ulnar nerve in crossed pinning is minimised by palpating the medial epicondyle and placing the entry point anterior to the ulnar nerve. Materials and Methods: Twenty Five cases of Gartland Type III supracondylar fractures of humerus in children from December 2016 – May 2018 treated by closed reduction and crossed percutaneous pinning under C-arm was included in the study. Medial and lateral pins are preferable to multiple lateral pins as it provides more stability. The patients were followed up clinically and radiologically in the 3rd, 6th and 12th week postoperatively and their recovery assessed according to Flynn’s criteria.Result: Among the patients in the study, in whom the fracture was treated by closed reduction and crossed k-wire fixation and assessed using Flynn’s criteria, 88% of the patients had excellent results, 8% had good results. Altogether 96% of the patients had satisfactory results.Conclusion: Closed reduction and crossed percutaneous pinning is a safe, stable and effective technique for the treatment of supracondylar fracture in children with a satisfactory outcome.

Suprakondilarni prelomi humerusa kod dece

INTRODUCTION: Supracondylar fractures of the humerus occupy a significant place in the morbidity of children. The success in treating these fractures certainly depends on the timely diagnosis, the speed of transport and the quality of nursing care. Aim. Observe differences in children with supracondylary fracture of the humerus compared to the applied treatment method. Material and methods. The research was conducted at the Institute for Health Care of Children and Youth of Vojvodina in Novi Sad using custom questionnaires and disease history to obtain relevant data that was statistically processed. RESULTS: Supracondylar elbow fractures are in third place by frequency. The largest number of respondents belongs to the age category of 7-9 years. Injuries are more often on the left hand. The majority of respondents from both groups suffered injuries in May, a fall in the game. In 63.3% of respondents from both groups passed from 0 to 2h from the moment of injuries to the intervention. A statistically significant difference exists in the mode of transport between patients treated with conservative and operative pathways. CONCLUSION: In the case of supracondylary fractures in children, properly installed transport immobilization and faster transport to a health institution, the risk of complications and the need for an open reduction are reduced. Reduced length of hospitalization allows for quicker return to daily activities, reduction of the possibility of intrahospital infections, and reduction of treatment costs.

A comparison of fluoroscopic exposure and operative time during treatment of displaced supracondylar elbow fractures in children

Background Intraoperative fluoroscopy can potentially expose the surgeon to levels of radiation beyond the recommended limits. This study aimed to assess the intraoperative differences between the fixation of types 2 and 3 supracondylar fractures for fluoroscopy time, operative time, direction of displacement, and potential cumulative risk of radiation to the surgeon. Methods Retrospective chart analysis was used to review 74 consecutive subjects with type 2 or 3 extension supracondylar fractures over a six-year period. Closed reduction and percutaneous pinning with fluoroscopy was used in all cases. Fluoroscopy time and operative time were analyzed based on the fracture type, direction of initial displacement, and the number of K-wires used. Results Type 2 supracondylar fractures require less fluoroscopy (mean: 16.8 s) and are shorter operations (mean: 19.2 min) when compared to type 3 (26.2 s and 25.1 min; p&lt;0.05). The direction of displacement (posteromedial vs. posterolateral) did not influence operative (23.8 vs. 26.5 min) or fluoroscopy times (27.6 vs. 24.9 s; p&gt;0.05). Conclusions Type 3 supracondylar fractures utilize more fluoroscopy time and operative time than type 2 fractures. The direction of displacement did not affect fluoroscopy time or operative time. Surgeons who perform large numbers of closed reduction and percutaneous pinning may be exposed to excess amounts of radiation.