Early versus delayed surgery for paediatric supracondylar humeral fractures in the absence of vascular compromise: A systematic review and meta-analysis

L. Farrow* (Corresponding Author), A. D. Ablett, L. Mills, S. Barker

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

22 Citations (Scopus)

Abstract

Aims: We set out to determine if there is a difference in perioperative outcomes between early and delayed surgery in paediatric supracondylar humeral fractures in the absence of vascular compromise through a systematic review and meta-analysis.

Materials and Methods: A literature search was performed, with search outputs screened for studies meeting the inclusion criteria. The groups of early surgery (ES) and delayed surgery (DS) were classified by study authors. The primary outcome measure was open reduction requirement. Meta-analysis was performed in the presence of sufficient study homogeneity. Individual study risk of bias was assessed using the Risk of Bias in Non-Randomised Studies – of Interventions (ROBINS-I) criteria, with the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) criteria used to evaluate outcomes independently.

Results: A total of 12 studies met the inclusion criteria (1735 fractures). Pooled mean time to surgery from injury was and 10.7 hours for ES and 91.8 hours for DS. On meta-analysis there was no significant difference between ES versus DS for the outcome of open reduction requirement. There was also no significant difference for the outcomes: Iatrogenic nerve injury, pin site infection, and re-operation. The quality of evidence for all the individual outcomes was low or very low.

Conclusions: There is no evidence that delaying supracondylar fracture surgery negatively influences outcomes in the absence of vascular compromise. There are, however, notable limitations to the existing available literature.

Original languageEnglish
Pages (from-to)1535-1541
Number of pages7
JournalBone and Joint Journal
Volume100B
Issue number12
Early online date30 Nov 2018
DOIs
Publication statusPublished - 1 Dec 2018

Bibliographical note

Funding statement: No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

This article was primary edited by G. Scott.

Data Availability Statement

Supplementary material (available online)
Tables showing the search strategy and highlighting the
risk of bias assessment for each individual study. Forest
plots of delayed versus early surgery

Keywords

  • Paediatrics
  • Trauma
  • Orthopaedics
  • Elbow
  • Supracondylar
  • Distal humerus
  • Gartland
  • Timing
  • Delay
  • Systematic review

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