Pediatric Supracondylar Humerus Fractures: Does After-Hours Treatment Influence Outcomes?

OBJECTIVE

To compare the outcomes of pediatric supracondylar humerus fractures treated during daytime hours to those treated after-hours.

DESIGN

Retrospective.

SETTING

Academic Level I trauma center.

PATIENTS/

PARTICIPANTS

Two hundred ninety-eight pediatric patients treated with surgical reduction and fixation of closed supracondylar fractures were included.

INTERVENTION: Seventy-seven patients underwent surgery during daytime hours (06:00-15:59 on weekdays). One hundred eighty-six patients underwent surgery after-hours (16:00-05:59 on weekdays and any surgery on weekends or holidays).

MAIN OUTCOME MEASURES: Surgeon subspecialty, operative duration, and radiographic and clinical outcomes, including range of motion and carrying angle, were extracted from the patient medical records.

RESULTS

There were no patient-related demographic differences between the daytime hours and after-hours groups. Daytime surgery was more likely to be performed by a pediatric orthopaedic surgeon than after-hours surgery. Fractures treated after-hours had more severe injury patterns. After-hours surgery was not independently associated with rate of open reduction, operative times, complications, achievement of functional range of motion, or radiographic alignment. A late-night surgery subgroup analysis demonstrated an increased rate of malunion in patients undergoing surgery between the hours of 23:00 and 05:59.

CONCLUSIONS

There is no difference in the operative duration or outcomes after surgical treatment of pediatric supracondylar humerus fractures performed after-hours when compared with daytime surgery. However, late-night surgery performed between 23:00 and 05:59 may be associated with a higher rate of malunion. Surgeons can use these data to make better-informed decisions about the timing of surgery in this patient population.

LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.