O3264: Assessment of Differences Regarding the Management of Pediatric Supracondylar Humerus Fractures Between Hand and Pediatric Orthopaedic Surgeons

Background: Supracondylar fractures of the humerus are a common injury in the pediatric population and are managed by various surgeons. Pediatric orthopaedics surgeons are not available at every hospital, thus adult hand surgeons may also provide the treatment of these fractures. The purpose of this study was to determine if any differences exist in the management and complications of pediatric supracondylar humerus fractures between pediatric orthopaedic surgeons and hand surgeons.

Methods: A retrospective chart review was performed to identify patients treated surgically for supracondylar humerus fractures over a 13-year period. Data collected included patient demographics, Gartland classification, preoperative nerve deficit, preoperative vascular injury if present, closed versus open reduction, operative time, complications, and physical therapy referral. Two groups of patients were established based on the treating physician: pediatric orthopaedic attending surgeons (PO) and adult hand attending surgeons (AH). Simple statistical analysis was performed.

Results: A total of 509 patients were identified; 367 patients were treated by a PO and 125 patients by an AH. AH opted to utilize open reduction and internal fixation significantly more often than PO, with a rate of 22.4% (n=28) versus 3.2% (n=12) (p < 0.001). Average operative times (AH: 63.3 minutes vs. PO: 37.2 minutes) and Gartland classification also differed between PO and AH surgeons. AH more frequently encountered Gartland Type III fractures (55.6%) followed by Gartland type II fractures (38.8%), whereas PO surgeons more frequently encountered Gartland Type II fractures (53.5%) followed by Gartland type III fractures (38.0%). PO, however, treated more Gartland type IV fractures compared to AH (8.5% vs. 2.3%). There were no differences in the complication rate, rate of preoperative nerve deficit, rate of preoperative concomitant vascular injury, or referrals to physical therapy.

Conclusion: Adult hand surgeons and pediatric orthopaedic surgeons treating pediatric supracondylar humerus fractures have similar patient outcomes and low complication rates. Differences exist regarding the management of these patients including the potential for substantially higher health care costs when these fractures are treated by hand surgeons due to the increased use of open reduction techniques and longer operative times.