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Three Part Question

in a [child aged 3-12] with a [spracondylar fracture of the humerus] is a [better outcome achieved with surgical intervention or immobilisation]

Clinical Scenario

An eight year old child presents with pain, swelling and local tenderness of the elbow, having fallen onto an outretched hand. a supracondylar fracture of the humerus is suspected. should this patient be treated with immobilisation or referred for surgery

Search Strategy

Medline 1966-June 20005
CINAHL 1982-June 2005
The Cochrane library, isuue 2 2005

Search Outcome

98 citations of which 2 high quality retrospective studies were found

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Palmer EE July 1978 USA	78 children (children's hospital)	retrospective clinical trial	volkmann's contracture	no instances following either mode of treatment	The study was promoting screws of their own deign, so possibly could be bias in interpreting results. Some patients discontinued follow up. Treatments not randomly allocated, varied depending on the state of the fracture (e.g. displaced or not; absent radial pulse or not) making comparisons between treatments difficult
			best mode of treatment	surgery associated with better oucome than immobilisation
			best mode of surgery	overhead traction associated with best outcome
			complications following surgery	rapid reolution of any neurovascular comprimise secondary to surgery
Weiland AJ July 1978 USA and Switzerland	52 chidren, aged 2-13 years old	retrospective review	complications following treatment	no cases of infection, non-union, anaesthetic complications, or evidence of myositis ossificans	statistical methods used are not described
			pre-operative neurovascular complications	all children had complete recovery within 14 days after surgery
			complications of surgery	no patient suffered neural or vascular injury secondary to surgery
			Angulation	13/52 patients had less valgus angulation compared to uninjured elbow following surgery. 1/52 patients developeed cubital varus deformity

Comment(s)

treatment of a supracondylar fracture of the humerus is a difficult task as this type of fracture is associated with many complications.

Clinical Bottom Line

surgical intervention leads to improved outcome in a supracondylar fracture of the humerus

References

1. Palmer EE Supracondylar fracture of the humerus in children
2. Weiland AJ Surgical treatment of displaced supracondylar fractures of the humerus in children