Agreement on fixation of pediatric supracondylar humerus fractures

Willemijn Spierenburg*, Anne Britt E. Dekker, Job N. Doornberg, Pieta Krijnen, Michel P.J. van den Bekerom, Inger B. Schipper, On behalf of the SOVG group

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

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.

Original languageEnglish
Pages (from-to)4277-4282
Number of pages6
JournalEuropean Journal of Trauma and Emergency Surgery
Volume48
Issue number5
Early online date16 Apr 2022
DOIs
Publication statusPublished - Oct 2022

Bibliographical note

Publisher Copyright: © 2022, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.

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