Pediatric Gartland Type-IV Supracondylar Humeral Fractures Have Substantial Overlap with Flexion-Type Fractures

Stuart L. Mitchell, Brian T. Sullivan, Christine A. Ho, Joshua M. Abzug, Micheal Raad, Paul David Sponseller

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Knowledge is limited about the diagnosis and treatment of modified Gartland type-IV supracondylar humeral fractures. We determined the prevalence of type-IV fractures, identified preoperative characteristics associated with these injuries, and assessed operative treatment characteristics. METHODS: We retrospectively identified patients <16 years of age who underwent operative treatment of a supracondylar humeral fracture at 2 centers between 2008 and 2016. We compared patient, injury, and treatment characteristics between type-IV and type-III fracture groups (1:4, cases:controls). Preoperative radiographs were assessed by 4 pediatric orthopaedists blinded to fracture type. The odds of a fracture being type IV were assessed using univariate logistic regression for individual radiographic parameters. Significance was set at alpha = 0.05. RESULTS: Type-IV fractures accounted for 39 (1.3%) of the supracondylar humeral fractures treated operatively during the study period. A type-IV fracture was associated with the following radiographic parameters: flexion angulation (odds ratio [OR] = 17; 95% confidence interval [CI] = 4.9 to 59), valgus angulation (OR = 5.6; 95% CI = 1.6 to 20), and lateral translation (OR = 4.1; 95% CI = 1.6 to 11) of the distal fragment; osseous apposition between the proximal and distal fragments (OR = 4.0; 95% CI = 1.8 to 9.0); and propagation of the fracture line toward the diaphysis of the proximal segment (OR = 9.2; 95% CI = 1.6 to 53). We found no significant differences in patient or injury characteristics between the groups. Compared with type-III fractures, type-IV fractures were treated more frequently with open reduction and percutaneous pinning (13% compared with 3.8%; p = 0.04) and were associated with longer mean operative time (82 ± 42 compared with 63 ± 28 minutes; p = 0.001). CONCLUSIONS: We identified 5 preoperative radiographic parameters associated with greater odds of a supracondylar humeral fracture being type IV rather than type III. No patient or injury characteristic differed significantly between the groups. Substantial overlap likely exists between type-IV and flexion-type fractures. Type-IV fractures were associated with longer operative time and were treated with open reduction more frequently than were type-III fractures. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Original languageEnglish (US)
Pages (from-to)1351-1356
Number of pages6
JournalThe Journal of bone and joint surgery. American volume
Volume101
Issue number15
DOIs
StatePublished - Aug 7 2019

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Humeral Fractures
Odds Ratio
Confidence Intervals
Pediatrics
Wounds and Injuries
Operative Time
Therapeutics
Diaphyses
Logistic Models

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Pediatric Gartland Type-IV Supracondylar Humeral Fractures Have Substantial Overlap with Flexion-Type Fractures. / Mitchell, Stuart L.; Sullivan, Brian T.; Ho, Christine A.; Abzug, Joshua M.; Raad, Micheal; Sponseller, Paul David.

In: The Journal of bone and joint surgery. American volume, Vol. 101, No. 15, 07.08.2019, p. 1351-1356.

Research output: Contribution to journalArticle

Mitchell, Stuart L. ; Sullivan, Brian T. ; Ho, Christine A. ; Abzug, Joshua M. ; Raad, Micheal ; Sponseller, Paul David. / Pediatric Gartland Type-IV Supracondylar Humeral Fractures Have Substantial Overlap with Flexion-Type Fractures. In: The Journal of bone and joint surgery. American volume. 2019 ; Vol. 101, No. 15. pp. 1351-1356.
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abstract = "BACKGROUND: Knowledge is limited about the diagnosis and treatment of modified Gartland type-IV supracondylar humeral fractures. We determined the prevalence of type-IV fractures, identified preoperative characteristics associated with these injuries, and assessed operative treatment characteristics. METHODS: We retrospectively identified patients <16 years of age who underwent operative treatment of a supracondylar humeral fracture at 2 centers between 2008 and 2016. We compared patient, injury, and treatment characteristics between type-IV and type-III fracture groups (1:4, cases:controls). Preoperative radiographs were assessed by 4 pediatric orthopaedists blinded to fracture type. The odds of a fracture being type IV were assessed using univariate logistic regression for individual radiographic parameters. Significance was set at alpha = 0.05. RESULTS: Type-IV fractures accounted for 39 (1.3{\%}) of the supracondylar humeral fractures treated operatively during the study period. A type-IV fracture was associated with the following radiographic parameters: flexion angulation (odds ratio [OR] = 17; 95{\%} confidence interval [CI] = 4.9 to 59), valgus angulation (OR = 5.6; 95{\%} CI = 1.6 to 20), and lateral translation (OR = 4.1; 95{\%} CI = 1.6 to 11) of the distal fragment; osseous apposition between the proximal and distal fragments (OR = 4.0; 95{\%} CI = 1.8 to 9.0); and propagation of the fracture line toward the diaphysis of the proximal segment (OR = 9.2; 95{\%} CI = 1.6 to 53). We found no significant differences in patient or injury characteristics between the groups. Compared with type-III fractures, type-IV fractures were treated more frequently with open reduction and percutaneous pinning (13{\%} compared with 3.8{\%}; p = 0.04) and were associated with longer mean operative time (82 ± 42 compared with 63 ± 28 minutes; p = 0.001). CONCLUSIONS: We identified 5 preoperative radiographic parameters associated with greater odds of a supracondylar humeral fracture being type IV rather than type III. No patient or injury characteristic differed significantly between the groups. Substantial overlap likely exists between type-IV and flexion-type fractures. Type-IV fractures were associated with longer operative time and were treated with open reduction more frequently than were type-III fractures. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.",
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T1 - Pediatric Gartland Type-IV Supracondylar Humeral Fractures Have Substantial Overlap with Flexion-Type Fractures

AU - Mitchell, Stuart L.

AU - Sullivan, Brian T.

AU - Ho, Christine A.

AU - Abzug, Joshua M.

AU - Raad, Micheal

AU - Sponseller, Paul David

PY - 2019/8/7

Y1 - 2019/8/7

N2 - BACKGROUND: Knowledge is limited about the diagnosis and treatment of modified Gartland type-IV supracondylar humeral fractures. We determined the prevalence of type-IV fractures, identified preoperative characteristics associated with these injuries, and assessed operative treatment characteristics. METHODS: We retrospectively identified patients <16 years of age who underwent operative treatment of a supracondylar humeral fracture at 2 centers between 2008 and 2016. We compared patient, injury, and treatment characteristics between type-IV and type-III fracture groups (1:4, cases:controls). Preoperative radiographs were assessed by 4 pediatric orthopaedists blinded to fracture type. The odds of a fracture being type IV were assessed using univariate logistic regression for individual radiographic parameters. Significance was set at alpha = 0.05. RESULTS: Type-IV fractures accounted for 39 (1.3%) of the supracondylar humeral fractures treated operatively during the study period. A type-IV fracture was associated with the following radiographic parameters: flexion angulation (odds ratio [OR] = 17; 95% confidence interval [CI] = 4.9 to 59), valgus angulation (OR = 5.6; 95% CI = 1.6 to 20), and lateral translation (OR = 4.1; 95% CI = 1.6 to 11) of the distal fragment; osseous apposition between the proximal and distal fragments (OR = 4.0; 95% CI = 1.8 to 9.0); and propagation of the fracture line toward the diaphysis of the proximal segment (OR = 9.2; 95% CI = 1.6 to 53). We found no significant differences in patient or injury characteristics between the groups. Compared with type-III fractures, type-IV fractures were treated more frequently with open reduction and percutaneous pinning (13% compared with 3.8%; p = 0.04) and were associated with longer mean operative time (82 ± 42 compared with 63 ± 28 minutes; p = 0.001). CONCLUSIONS: We identified 5 preoperative radiographic parameters associated with greater odds of a supracondylar humeral fracture being type IV rather than type III. No patient or injury characteristic differed significantly between the groups. Substantial overlap likely exists between type-IV and flexion-type fractures. Type-IV fractures were associated with longer operative time and were treated with open reduction more frequently than were type-III fractures. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

AB - BACKGROUND: Knowledge is limited about the diagnosis and treatment of modified Gartland type-IV supracondylar humeral fractures. We determined the prevalence of type-IV fractures, identified preoperative characteristics associated with these injuries, and assessed operative treatment characteristics. METHODS: We retrospectively identified patients <16 years of age who underwent operative treatment of a supracondylar humeral fracture at 2 centers between 2008 and 2016. We compared patient, injury, and treatment characteristics between type-IV and type-III fracture groups (1:4, cases:controls). Preoperative radiographs were assessed by 4 pediatric orthopaedists blinded to fracture type. The odds of a fracture being type IV were assessed using univariate logistic regression for individual radiographic parameters. Significance was set at alpha = 0.05. RESULTS: Type-IV fractures accounted for 39 (1.3%) of the supracondylar humeral fractures treated operatively during the study period. A type-IV fracture was associated with the following radiographic parameters: flexion angulation (odds ratio [OR] = 17; 95% confidence interval [CI] = 4.9 to 59), valgus angulation (OR = 5.6; 95% CI = 1.6 to 20), and lateral translation (OR = 4.1; 95% CI = 1.6 to 11) of the distal fragment; osseous apposition between the proximal and distal fragments (OR = 4.0; 95% CI = 1.8 to 9.0); and propagation of the fracture line toward the diaphysis of the proximal segment (OR = 9.2; 95% CI = 1.6 to 53). We found no significant differences in patient or injury characteristics between the groups. Compared with type-III fractures, type-IV fractures were treated more frequently with open reduction and percutaneous pinning (13% compared with 3.8%; p = 0.04) and were associated with longer mean operative time (82 ± 42 compared with 63 ± 28 minutes; p = 0.001). CONCLUSIONS: We identified 5 preoperative radiographic parameters associated with greater odds of a supracondylar humeral fracture being type IV rather than type III. No patient or injury characteristic differed significantly between the groups. Substantial overlap likely exists between type-IV and flexion-type fractures. Type-IV fractures were associated with longer operative time and were treated with open reduction more frequently than were type-III fractures. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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