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Wagner F, Boeriu A, Eberz P, Weigert A, Holzapfel BM, Böcker W, Hubertus J, Muensterer O, Bergmann F, Ziegler CM. Intrainstitutional Changes of the Treatment of Supracondylar Humerus Fracture in Children over a Period of 9 Years. Children (Basel) 2023; 11:27. [PMID: 38255341 PMCID: PMC10814588 DOI: 10.3390/children11010027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 12/07/2023] [Accepted: 12/23/2023] [Indexed: 01/24/2024]
Abstract
To assess changes in treatment modalities for supracondylar humerus fractures (SCHFs) at a large pediatric university hospital, we analyzed patient data from 2014 to 2022. A total of 233 SCHFs treated surgically at our hospital were included. To evaluate postoperative outcome and quality of life, DASH and EuroQol-5D-Y questionnaires were sent to patients. In addition to a significant fluctuation in fracture severity, we found an increase in training interventions (more surgeries were performed by trainees) and a significant decrease in surgery times after 2016. From 2020, there was a significant shift in the type of surgical method away from closed reduction with elastic stable intramedullary nailing (ESIN) and towards closed reduction and crossed K-wire osteosynthesis (CRK). Surgeries performed in the morning and evening hours increased, while those performed in the afternoon and after midnight decreased. After a mean follow-up of 4 years, there was no difference in elbow function between ESIN and open reduction and K-wires (ORK). Treatment with ESIN was equivalent to ORK in terms of function, at least in the medium-term follow-up. In summary, the combination of shifting treatment from SCHF to daytime hours, increasing trainee participation and using cross K-wire fixation instead of ESIN had no negative impact on surgery times. In our setting, these measures have reduced resource utilization and increased efficiency without compromising patient care.
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Affiliation(s)
- Ferdinand Wagner
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, Ludwig-Maximilians-Universität München, Marchioninistrasse 15, 81377 Munich, Germany (B.M.H.); (C.M.Z.)
- Institute of Health and Biomedical Innovation, Queensland University of Technology (QUT), Brisbane, QLD 4059, Australia
- Department of Pediatric Surgery, Dr. von Hauner Children’s Hospital, Ludwig-Maximilians-Universität München, Lindwurmstrasse 4, 80337 Munich, Germany; (J.H.); (O.M.)
| | - Amalia Boeriu
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, Ludwig-Maximilians-Universität München, Marchioninistrasse 15, 81377 Munich, Germany (B.M.H.); (C.M.Z.)
| | - Pascal Eberz
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, Ludwig-Maximilians-Universität München, Marchioninistrasse 15, 81377 Munich, Germany (B.M.H.); (C.M.Z.)
| | - Annabelle Weigert
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, Ludwig-Maximilians-Universität München, Marchioninistrasse 15, 81377 Munich, Germany (B.M.H.); (C.M.Z.)
| | - Boris Michael Holzapfel
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, Ludwig-Maximilians-Universität München, Marchioninistrasse 15, 81377 Munich, Germany (B.M.H.); (C.M.Z.)
| | - Wolfgang Böcker
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, Ludwig-Maximilians-Universität München, Marchioninistrasse 15, 81377 Munich, Germany (B.M.H.); (C.M.Z.)
| | - Jochen Hubertus
- Department of Pediatric Surgery, Dr. von Hauner Children’s Hospital, Ludwig-Maximilians-Universität München, Lindwurmstrasse 4, 80337 Munich, Germany; (J.H.); (O.M.)
| | - Oliver Muensterer
- Department of Pediatric Surgery, Dr. von Hauner Children’s Hospital, Ludwig-Maximilians-Universität München, Lindwurmstrasse 4, 80337 Munich, Germany; (J.H.); (O.M.)
| | - Florian Bergmann
- Department of Pediatric Surgery, Dr. von Hauner Children’s Hospital, Ludwig-Maximilians-Universität München, Lindwurmstrasse 4, 80337 Munich, Germany; (J.H.); (O.M.)
| | - Christian Max Ziegler
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, Ludwig-Maximilians-Universität München, Marchioninistrasse 15, 81377 Munich, Germany (B.M.H.); (C.M.Z.)
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Sullivan MH, Wahlig BD, Broida SE, Larson AN, Shaughnessy WJ, Stans AA, Milbrandt TA. Response to Letter to the Editor, Regarding Grauberger et al, 2020 and Sullivan et al, 2023. J Pediatr Orthop 2023; 43:e828-e829. [PMID: 37661838 DOI: 10.1097/bpo.0000000000002503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
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Blakemore L, Garg S, Goodwin R, Gordon JE, Hahn G, Mehlman CT, Mencio G, Rathjen K, Sabatini C, Schmale G, Skaggs DL. Letter to the Editor: Grauberger et al, J Pediatr Orthop , 2020 and Sullivan et al, J Pediatr Orthop , 2020. J Pediatr Orthop 2023; 43:e828. [PMID: 37599613 DOI: 10.1097/bpo.0000000000002501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Affiliation(s)
| | | | | | | | - Gregory Hahn
- Johns Hopkins All Children's Hospital St. Petersburg, FL
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Rehm A, Shehata R, Elerian S, Clegg R, Linardatou Novak P. Does Shorter Time to Treatment of Pediatric Supracondylar Humerus Fractures Impact Clinical Outcomes? J Pediatr Orthop 2023:01241398-990000000-00408. [PMID: 37904507 DOI: 10.1097/bpo.0000000000002557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2023]
Affiliation(s)
- Andreas Rehm
- Department of Paediatric Orthopaedics Cambridge University Hospitals NHS Trust
| | | | | | - Rachael Clegg
- Department of Paediatric Orthopaedics Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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