Variation among Pediatric Orthopaedic Surgeons When Treating Medial Epicondyle Fractures

Meghan Hughes, Karan Dua, Nathan N. O'Hara, Brian K. Brighton, Theodore J. Ganley, William L. Hennrikus, Martin J. Herman, Joshua E. Hyman, J. Todd Lawrence, Charles T. Mehlman, Kenneth J. Noonan, Norman Y. Otsuka, Richard M. Schwend, M. Wade Shrader, Brian G. Smith, Paul David Sponseller, Joshua M. Abzug

Research output: Contribution to journalArticle

Abstract

Background:Medial epicondyle fractures are a common pediatric and adolescent injury accounting for 11% to 20% of elbow fractures in this population. This purpose of this study was to determine the variability among pediatric orthopaedic surgeons when treating pediatric medial epicondyle fractures.Methods:A discrete choice experiment was conducted to determine which patient and injury attributes influence the management of medial epicondyle fractures by pediatric orthopaedic surgeons. A convenience sample of 13 pediatric orthopaedic surgeons reviewed 60 case vignettes of medial epicondyle fractures that included elbow radiographs and patient/injury characteristics. Displacement was incorporated into the study model as a fixed effect. Surgeons were queried if they would treat the injury with immobilization alone or open reduction and internal fixation (ORIF). Statistical analysis was performed using a mixed effect regression model. In addition, surgeons filled out a demographic questionnaire and a risk assessment to determine if these factors affected clinical decision-making.Results:Elbow dislocation and fracture displacement were the only attributes that significantly influenced surgeons to perform surgery (P<0.05). The presence of an elbow dislocation had the largest impact on surgeons when choosing operative care (β=-0.14; P=0.02). In addition, for every 1 mm increase in displacement, surgeons tended to favor ORIF by a factor of 0.09 (P<0.01). Sex, mechanism of injury, and sport participation did not influence decision-making. In total, 54% of the surgeons demonstrated a preference for ORIF for the included scenarios. On the basis of the personality Likert scale, participants were neither high-risk takers nor extremely risk adverse with an average-risk score of 2.24. Participant demographics did not influence decision-making.Conclusions:There is substantial variation among pediatric orthopaedic surgeons when treating medial epicondyle fractures. The decision to operate is significantly based on the degree of fracture displacement and if there is a concomitant elbow dislocation. There is no standardization regarding how to treat medial epicondyle fractures and better treatment algorithms are needed to provide better patient outcomes.Level of Evidence:Level V.

Original languageEnglish (US)
Pages (from-to)e592-e596
JournalJournal of Pediatric Orthopaedics
Volume39
Issue number8
DOIs
StatePublished - Sep 1 2019

Fingerprint

Elbow
Pediatrics
Wounds and Injuries
Decision Making
Demography
Athletic Injuries
Immobilization
Personality
Surgeons
Orthopedic Surgeons
Population
Therapeutics

Keywords

  • discrete choice experiment
  • fracture
  • medial epicondyle
  • pediatric
  • treatment
  • variation

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Orthopedics and Sports Medicine

Cite this

Hughes, M., Dua, K., O'Hara, N. N., Brighton, B. K., Ganley, T. J., Hennrikus, W. L., ... Abzug, J. M. (2019). Variation among Pediatric Orthopaedic Surgeons When Treating Medial Epicondyle Fractures. Journal of Pediatric Orthopaedics, 39(8), e592-e596. https://doi.org/10.1097/BPO.0000000000001092

Variation among Pediatric Orthopaedic Surgeons When Treating Medial Epicondyle Fractures. / Hughes, Meghan; Dua, Karan; O'Hara, Nathan N.; Brighton, Brian K.; Ganley, Theodore J.; Hennrikus, William L.; Herman, Martin J.; Hyman, Joshua E.; Lawrence, J. Todd; Mehlman, Charles T.; Noonan, Kenneth J.; Otsuka, Norman Y.; Schwend, Richard M.; Shrader, M. Wade; Smith, Brian G.; Sponseller, Paul David; Abzug, Joshua M.

In: Journal of Pediatric Orthopaedics, Vol. 39, No. 8, 01.09.2019, p. e592-e596.

Research output: Contribution to journalArticle

Hughes, M, Dua, K, O'Hara, NN, Brighton, BK, Ganley, TJ, Hennrikus, WL, Herman, MJ, Hyman, JE, Lawrence, JT, Mehlman, CT, Noonan, KJ, Otsuka, NY, Schwend, RM, Shrader, MW, Smith, BG, Sponseller, PD & Abzug, JM 2019, 'Variation among Pediatric Orthopaedic Surgeons When Treating Medial Epicondyle Fractures', Journal of Pediatric Orthopaedics, vol. 39, no. 8, pp. e592-e596. https://doi.org/10.1097/BPO.0000000000001092
Hughes, Meghan ; Dua, Karan ; O'Hara, Nathan N. ; Brighton, Brian K. ; Ganley, Theodore J. ; Hennrikus, William L. ; Herman, Martin J. ; Hyman, Joshua E. ; Lawrence, J. Todd ; Mehlman, Charles T. ; Noonan, Kenneth J. ; Otsuka, Norman Y. ; Schwend, Richard M. ; Shrader, M. Wade ; Smith, Brian G. ; Sponseller, Paul David ; Abzug, Joshua M. / Variation among Pediatric Orthopaedic Surgeons When Treating Medial Epicondyle Fractures. In: Journal of Pediatric Orthopaedics. 2019 ; Vol. 39, No. 8. pp. e592-e596.
@article{4053c193de064aeca646451ad249d7cd,
title = "Variation among Pediatric Orthopaedic Surgeons When Treating Medial Epicondyle Fractures",
abstract = "Background:Medial epicondyle fractures are a common pediatric and adolescent injury accounting for 11{\%} to 20{\%} of elbow fractures in this population. This purpose of this study was to determine the variability among pediatric orthopaedic surgeons when treating pediatric medial epicondyle fractures.Methods:A discrete choice experiment was conducted to determine which patient and injury attributes influence the management of medial epicondyle fractures by pediatric orthopaedic surgeons. A convenience sample of 13 pediatric orthopaedic surgeons reviewed 60 case vignettes of medial epicondyle fractures that included elbow radiographs and patient/injury characteristics. Displacement was incorporated into the study model as a fixed effect. Surgeons were queried if they would treat the injury with immobilization alone or open reduction and internal fixation (ORIF). Statistical analysis was performed using a mixed effect regression model. In addition, surgeons filled out a demographic questionnaire and a risk assessment to determine if these factors affected clinical decision-making.Results:Elbow dislocation and fracture displacement were the only attributes that significantly influenced surgeons to perform surgery (P<0.05). The presence of an elbow dislocation had the largest impact on surgeons when choosing operative care (β=-0.14; P=0.02). In addition, for every 1 mm increase in displacement, surgeons tended to favor ORIF by a factor of 0.09 (P<0.01). Sex, mechanism of injury, and sport participation did not influence decision-making. In total, 54{\%} of the surgeons demonstrated a preference for ORIF for the included scenarios. On the basis of the personality Likert scale, participants were neither high-risk takers nor extremely risk adverse with an average-risk score of 2.24. Participant demographics did not influence decision-making.Conclusions:There is substantial variation among pediatric orthopaedic surgeons when treating medial epicondyle fractures. The decision to operate is significantly based on the degree of fracture displacement and if there is a concomitant elbow dislocation. There is no standardization regarding how to treat medial epicondyle fractures and better treatment algorithms are needed to provide better patient outcomes.Level of Evidence:Level V.",
keywords = "discrete choice experiment, fracture, medial epicondyle, pediatric, treatment, variation",
author = "Meghan Hughes and Karan Dua and O'Hara, {Nathan N.} and Brighton, {Brian K.} and Ganley, {Theodore J.} and Hennrikus, {William L.} and Herman, {Martin J.} and Hyman, {Joshua E.} and Lawrence, {J. Todd} and Mehlman, {Charles T.} and Noonan, {Kenneth J.} and Otsuka, {Norman Y.} and Schwend, {Richard M.} and Shrader, {M. Wade} and Smith, {Brian G.} and Sponseller, {Paul David} and Abzug, {Joshua M.}",
year = "2019",
month = "9",
day = "1",
doi = "10.1097/BPO.0000000000001092",
language = "English (US)",
volume = "39",
pages = "e592--e596",
journal = "Journal of Pediatric Orthopaedics",
issn = "0271-6798",
publisher = "Lippincott Williams and Wilkins",
number = "8",

}

TY - JOUR

T1 - Variation among Pediatric Orthopaedic Surgeons When Treating Medial Epicondyle Fractures

AU - Hughes, Meghan

AU - Dua, Karan

AU - O'Hara, Nathan N.

AU - Brighton, Brian K.

AU - Ganley, Theodore J.

AU - Hennrikus, William L.

AU - Herman, Martin J.

AU - Hyman, Joshua E.

AU - Lawrence, J. Todd

AU - Mehlman, Charles T.

AU - Noonan, Kenneth J.

AU - Otsuka, Norman Y.

AU - Schwend, Richard M.

AU - Shrader, M. Wade

AU - Smith, Brian G.

AU - Sponseller, Paul David

AU - Abzug, Joshua M.

PY - 2019/9/1

Y1 - 2019/9/1

N2 - Background:Medial epicondyle fractures are a common pediatric and adolescent injury accounting for 11% to 20% of elbow fractures in this population. This purpose of this study was to determine the variability among pediatric orthopaedic surgeons when treating pediatric medial epicondyle fractures.Methods:A discrete choice experiment was conducted to determine which patient and injury attributes influence the management of medial epicondyle fractures by pediatric orthopaedic surgeons. A convenience sample of 13 pediatric orthopaedic surgeons reviewed 60 case vignettes of medial epicondyle fractures that included elbow radiographs and patient/injury characteristics. Displacement was incorporated into the study model as a fixed effect. Surgeons were queried if they would treat the injury with immobilization alone or open reduction and internal fixation (ORIF). Statistical analysis was performed using a mixed effect regression model. In addition, surgeons filled out a demographic questionnaire and a risk assessment to determine if these factors affected clinical decision-making.Results:Elbow dislocation and fracture displacement were the only attributes that significantly influenced surgeons to perform surgery (P<0.05). The presence of an elbow dislocation had the largest impact on surgeons when choosing operative care (β=-0.14; P=0.02). In addition, for every 1 mm increase in displacement, surgeons tended to favor ORIF by a factor of 0.09 (P<0.01). Sex, mechanism of injury, and sport participation did not influence decision-making. In total, 54% of the surgeons demonstrated a preference for ORIF for the included scenarios. On the basis of the personality Likert scale, participants were neither high-risk takers nor extremely risk adverse with an average-risk score of 2.24. Participant demographics did not influence decision-making.Conclusions:There is substantial variation among pediatric orthopaedic surgeons when treating medial epicondyle fractures. The decision to operate is significantly based on the degree of fracture displacement and if there is a concomitant elbow dislocation. There is no standardization regarding how to treat medial epicondyle fractures and better treatment algorithms are needed to provide better patient outcomes.Level of Evidence:Level V.

AB - Background:Medial epicondyle fractures are a common pediatric and adolescent injury accounting for 11% to 20% of elbow fractures in this population. This purpose of this study was to determine the variability among pediatric orthopaedic surgeons when treating pediatric medial epicondyle fractures.Methods:A discrete choice experiment was conducted to determine which patient and injury attributes influence the management of medial epicondyle fractures by pediatric orthopaedic surgeons. A convenience sample of 13 pediatric orthopaedic surgeons reviewed 60 case vignettes of medial epicondyle fractures that included elbow radiographs and patient/injury characteristics. Displacement was incorporated into the study model as a fixed effect. Surgeons were queried if they would treat the injury with immobilization alone or open reduction and internal fixation (ORIF). Statistical analysis was performed using a mixed effect regression model. In addition, surgeons filled out a demographic questionnaire and a risk assessment to determine if these factors affected clinical decision-making.Results:Elbow dislocation and fracture displacement were the only attributes that significantly influenced surgeons to perform surgery (P<0.05). The presence of an elbow dislocation had the largest impact on surgeons when choosing operative care (β=-0.14; P=0.02). In addition, for every 1 mm increase in displacement, surgeons tended to favor ORIF by a factor of 0.09 (P<0.01). Sex, mechanism of injury, and sport participation did not influence decision-making. In total, 54% of the surgeons demonstrated a preference for ORIF for the included scenarios. On the basis of the personality Likert scale, participants were neither high-risk takers nor extremely risk adverse with an average-risk score of 2.24. Participant demographics did not influence decision-making.Conclusions:There is substantial variation among pediatric orthopaedic surgeons when treating medial epicondyle fractures. The decision to operate is significantly based on the degree of fracture displacement and if there is a concomitant elbow dislocation. There is no standardization regarding how to treat medial epicondyle fractures and better treatment algorithms are needed to provide better patient outcomes.Level of Evidence:Level V.

KW - discrete choice experiment

KW - fracture

KW - medial epicondyle

KW - pediatric

KW - treatment

KW - variation

UR - http://www.scopus.com/inward/record.url?scp=85071240934&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85071240934&partnerID=8YFLogxK

U2 - 10.1097/BPO.0000000000001092

DO - 10.1097/BPO.0000000000001092

M3 - Article

VL - 39

SP - e592-e596

JO - Journal of Pediatric Orthopaedics

JF - Journal of Pediatric Orthopaedics

SN - 0271-6798

IS - 8

ER -