![]() This same study also demonstrated that there is a learning curve of approximately 20 patients with supracondylar humerus fractures treated surgically (close or open reduction) to positively impact operative time and radiographic outcomes. noted that the low‐volume surgeons (treating less than five type III supracondylar fractures/year) had a higher frequency of performing open reduction and had worse postoperative radiographic alignment than those fractures treated by higher volume surgeons. In a retrospective review of 236 surgically treated type III supracondylar fractures at a single institution, Pesenti et al. In those children where the indication to convert to open reduction was secondary to change in vascular status after attempted closed reduction, neurovascular structures were entrapped at the fracture site. Among those treated with ORIF, the indication in the majority (93%) of cases to convert to open treatment was secondary to irreducibility of fracture fragments – 40% due to fracture instability, 36% secondary to brachialis interposition, 16% due to periosteal interposition, and 8% secondary to triceps interposition. in their retrospective review found that the incidence of conversion from closed to open reduction was 7%. 1 In another study of pediatric closed type III supracondylar humerus fractures, there was a 9.4% rate of conversion following an attempted closed reduction to an open reduction, 2, 3 Novais et al. They also found that, as displaced supracondylar fractures are more often being transferred to tertiary care facilities and being treated by fellowship‐trained pediatric orthopedic surgeons, the rates of performing open reductions are trending down. ![]() Among surgically treated supracondylar humerus fractures, there is a 12.7% rate of open reduction. Change in neurologic exam or vascular exam (for the worse) following closed reduction of a supracondylar fracture.Īccording to Holt et al., nationally 24% of children with supracondylar humerus fractures undergo surgery in the US.Hand is poorly perfused following reduction and fixation.Unable to obtain an acceptable alignment of the fracture fragments using closed reduction.However, there are supracondylar humerus fractures that necessitate an open reduction.Īn open reduction is indicated in the following situations: The gold standard in the treatment of displaced pediatric supracondylar humerus fractures is closed reduction with percutaneous pinning. Question 1: In children with a supracondylar humerus fracture, when should an open reduction be performed instead of a closed reduction to ensure optimal outcomes? In a child who presents with a supracondylar humerus fracture without a palpable pulse, when should a vascular, open exploration be performed to optimize outcomes?. ![]()
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