Radiographic considerations for pediatric supracondylar humerus fractures.

Journal and index pages often block iframe embedding. This reader keeps the evidence details in Orthonotes and leaves the source page one click away.

Abstract

[Indexed for MEDLINE] 9. Eur J Trauma Emerg Surg. 2022 Oct;48(5):4277-4282. doi: 10.1007/s00068-022-01970-7. Epub 2022 Apr 16. Agreement on fixation of pediatric supracondylar humerus fractures. Spierenburg W(1), Dekker ABE(2), Doornberg JN(3), Krijnen P(2), van den Bekerom MPJ(4), Schipper IB(2); SOVG group. Collaborators: Van Dulken E, Van Dijkman B, Kootstra J, Schep N, Kloen P, Zwaving H, Pranger M, Meylaerts S, Krug E, van Luijt P, Sintenie JB, van Deurzen D, Alta T, Heijnen L, van Hove D, van der Zwaal P, Dorrestijn O, Campo M, Lansdaal J, Janus G, Raven E, van Doorn R, Burgers A, Vochteloo A, Eygendaal D, Tanka A, Goslings C, Verhofstad M, van der Veen A, Breederveld R, El Moumni M, Beeres F, Greeven A, van Helden S, Harbers J, Bartlema KA, van der Vlies K, Zuidema W, van de Sande M, Termaat F, van der Wal R. Author information: (1)MST, Koningstraat 1, 7512 KZ, Enschede, The Netherlands. wspierenburg@hotmail.com. (2)LUMC, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands. (3)UMCG, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands. (4)OLVG Hospital, Oosterpark 9, 1091 AC, Amsterdam, The Netherlands. BACKGROUND: Pediatric supracondylar humerus fractures (pSCHFs) may be challenging injuries to treat because of the potential residual deformity. There is debate regarding the technical aspects of adequate closed reduction and crossed Kirschner wire (K-wire) fixation. PURPOSE: Do surgeons have an agreement on the aspects of the fixation of pSCHFs? METHODS: Radiographs of 20 patients from a cohort of 154 patients with pSCHFs treated with closed reduction and crossed K-wire fixation were selected. Forty-four surgeons viewed the postoperative radiographs and diagnosed the presence or absence of technical flaws and made a recommendation for or against reoperation. An expert panel of three orthopedic and trauma surgeons provided a reference standard for technical factors. Furthermore, final outcome 2 years after trauma was assessed. RESULTS: There was limited agreement on potential technical flaws (ICC 0.15-0.28), radiographic measures of alignment (ICC for anterior humeral line and Baumann angle of 0.37 and 0.23 respectively), the quality of postoperative reduction, position of the elbow in cast, and recommendation for repeat surgery (ICCs between 0.23 and 0.40). Sensitivity and specificity for these questions ranged from 0.59 to 0.90. There was no correlation between the voted quality of postoperative reduction and loss of reduction or final function. CONCLUSIONS: Surgeons have limited agreement on the quality of postoperative results in pSCHFs and the indication for reoperation. Reviewing postoperative radiographs may present a good learning opportunity and could help improve skills, but it is not a validated method for quality control and has to be seen in light of clinical outcome. © 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany. DOI: 10.1007/s00068-022-01970-7