Time of surgery and surgeon level in supracondylar humerus fractures in pediatric patients: A retrospective study

Table 1 Demographic data of supracondylar fracture cohort

Variables, n (%)
Time of surgery	During working hours	87 (56.1)
	After working hours	68 (43.9)
Surgeon level	Pediatric orthopedic consultant	44 (28.4)
	Non-pediatric orthopedic consultant	38 (24.5)
	Trainee	73 (47.1)
Gender	Male	105 (67.7)
	Female	50 (32.3)
Mechanism	Fall on outstretched hand	112 (72.3)
	Fall on flexed elbow	17 (11)
	Direct	15 (9.7)
	Motor vehicle accident	8 (5.2)
	Others	3 (1.9)
Pre-operative nerve injury	Yes	4 (2.6)
	No	151 (97.4)
Pulse	Intact	141 (91)
	Absent	14 (9)
Classification	Gartland type 2	32 (20.6)
	Gartland type 3	115 (74.2)
	Flexion type	8 (5.2)
Procedure	Open reduction	24 (15.5)
	Close reduction	131 (84.5)
K-wire arrangement	Parallel	75 (48.4)
	Medial & lateral	35 (22.6)
	Two lateral & one medial	34 (21.9)
	Others	11 (7.1)

Table 2 Percentages of complications by variable and P value

Variables		Complication, n (%), n = 155
		Yes, n = 16 (10.3)	No, n = 139 (89.7)	P value
Time of surgery	During working hours	5 (5.7)	82 (94.3)	0.019
	After working hours	12 (17.6)	56 (82.4)
Surgeon level	Pediatric orthopaedic consultant	4 (9.1)	40 (90.9)	0.841
	Non-pediatric orthopaedic consultant	5 (13.2)	33 (86.8)
	Trainee	8 (11)	65 (89)
Gender	Male	10 (9.5)	95 (90.5)	0.404
	Female	7 (14)	43 (86)
Classification	Gartland type 2	2 (6.3)	30 (93.7)	0.308
	Gartland type 3	13 (11.3)	102 (88.7)
	Flexion type	2 (25)	6 (75)
Procedure	Open reduction	8 (33.3)	16 (66.7)	0.001
	Close reduction	9 (6.9)	122 (93.1)
K-wire arrangement	Parallel	6 (8)	69 (92)	0.154
	Medial & lateral	4 (11.4)	31 (88.6)
	Two lateral & one medial	7 (20.6)	27 (79.4)
	Others	0 (0)	11 (100)

Table 3 Previous studies assessing effect of time of surgery on outcomes of pediatric supracondylar humeral fractures

Ref.	Sample size	Groups	Results
Suganuma et al[19], 2020	120 Gartland type II and III SCHF	Surgeries within 12 h of injury and > 12 h	No difference in: Operative time; Early complications; Post-operative radiographic parameters
Aydoğmuş et al[18], 2017	91 Gartland type III SCHF	Daytime vs after hours surgery	Poor fixation rate in after hour surgery; No difference in operative time or residual deformity
Schmid et al[25], 2015	343 Gartland type II and III SCHF	Surgeries within 6 h, 6-12 h, 12-24 h and > 24 h from injury	No difference in: Outcome; Complications; Requiring open reduction
Mayne et al[26], 2014	115 Gartland type II and III SCHF	Surgeries within 12 h of injury and > 12 h	No difference in: Infection rate; Iatrogenic nerve injury; Requiring open reduction
Larson et al[27], 2014	399 Gartland type II SCHF	Surgeries within 24 h of injury and > 24 h	No difference in complication rate
Yildirim et al[28], 2009	190 Gartland type III SCHF	Time from injury to surgery	4 fold increase in requiring open reduction for each 5 hour delay
Walmsley et al[29], 2006	171 Gartland type III SCHF	Surgeries within 8 h of injury and > 8 h	No difference in complication rate; Higher risk of requiring open reduction in > 8 h group
Sibinski et al[30], 2006	77 Gartland type III SCHF	Surgeries within 12 h of injury and > 12 h	No difference in: Operative time; Outcome; Risk of open reduction
Gupta et al[20], 2004	150 operatively treated SCHF	Surgeries within 12 h of injury and > 12 h	No difference in: Pin tract infection; Iatrogenic nerve injury
Mehlman et al[15], 2001	198 operatively treated SCHF	Surgeries within 8 h of injury and > 8 h	No difference in: Pin tract infection; Iatrogenic nerve injury
Iyengar et al[31], 1999	58 Gartland type III SCHF	Surgeries within 8 h of injury and > 8 h	No difference in: Open reduction rate; Clinical outcomes

SCHF: Supracondylar humeral fractures.

Table 4 Previous studies assessing effect of surgeon level on outcomes of pediatric supracondylar humeral fractures

Ref.	Sample size	Groups	Results
Fisher et al[23], 2021	231 patients who underwent CRPP for SCHF	Pediatric orthopaedic fellowship trained vs other orthopaedic surgeons	Shorter operative and fluoroscopy time; No difference in complications
Osateerakun et al[32], 2019	87 Gartland type II and III SCHF	Pediatric orthopaedic fellowship trained vs other orthopaedic surgeons	Higher risk of complications in Gartland type III when not performed by pediatric orthopaedic surgeon; Overall complication rate and acceptable alignment were similar
Saarinen et al[17], 2019	108 operatively treated SCHF	Residents, pediatric surgeons and orthopaedic surgeons	Orthopaedic surgeons had the least complications and inadequate reductions; Residents had less complications and inadequate reductions when compared to pediatric surgeons
Pesenti et al[33], 2018	236 Gartland type III SCHF	Surgeons with < 1 yr vs > 1 yr experience	Less experienced had longer operative time; No difference in complication and malalignment rate
Tuomilehto et al[34], 2018	210 operatively treated SCHF	Consultants vs registrars	Higher complications and poorer outcomes in surgeries done by registrars
Liu et al[22], 2011	654 operatively treated SCHF	Fellows progression through fellowship training	No difference in complications and malunions throughout the fellowship year; Spike of malreductions at case 7 which improves at case 15
Padman et al[21], 2010	71 Gartland type II and III SCHF	Consultants vs trainees	Poorer outcome and more complications in surgeries performed by trainees without consultant supervision
Farley et al[24], 2008	444 operatively treated SCHF	Pediatric orthopaedic surgeon vs non-pediatric orthopaedic surgeon	No difference in complication rate and outcomes

CRPP: Closed reduction percutaneous pinning; SCHF: Supracondylar humeral fractures.