Supracondylar humerus fractures in low- and lower middle-income countries: a scoping review of the current epidemiology,
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ORIGINAL PAPER
Supracondylar humerus fractures in low- and lower middle-income countries: a scoping review of the current epidemiology, treatment modalities, and outcomes Sravya Challa 1,2
&
Kiran J. Agarwal-Harding 3,4 & Paul Levy 2 & Jill Barr-Walker 5 & Coleen S. Sabatini 2,6
Received: 8 April 2020 / Accepted: 29 June 2020 # SICOT aisbl 2020
Abstract Background The purpose of this scoping review was to examine the nature and quality of research regarding paediatric supracondylar humerus (SCH) fractures in low and lower middle-income countries (LICs). Methods We searched PubMed, Embase, Web of Science, and African Journals Online on January 9, 2018, for studies of SCH fractures in LICs. Studies were categorized by geographic region, Gartland classification of included patients, and study design. We evaluated each study’s methodology and conclusions. Results Out of 1805 results, we analyzed 105 studies, most of which included type 3 fractures only (66%). Many were conducted in South Asia (58%) and assessed treatment outcomes (78%). Most of the studies had level IV evidence (67%). Common limitations of research were small sample size (12%) and inadequate follow-up (6%). Epidemiological studies concluded that SCH fractures are more common among male children, are usually secondary to falls, and rarely present with nerve injuries. Most therapeutic studies reported outcomes of surgery (91%). Thirteen studies concluded that all-lateral versus cross-pinning techniques have similar outcomes. Seven studies reported preference for closed reduction over open reduction, when intra-operative fluoroscopy was available. Most common outcome measures were Flynn criteria (77%) and range of motion (53%). None of the papers looked at treatment costs. Conclusions Our data show a predominance of small level IV studies from LICs, with few studies of higher level of evidence. Many studies examined controversies with surgical technique, similar to studies performed in high-income countries. Few studies examined non-operative treatment, which is commonly the predominant treatment available for patients in LICs. Further investigation of common treatment modalities and outcomes for SCH fractures in LICs is needed. Keywords Fractures . Low and lower middle-income countries . Pediatric supracondylar humerus
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00264-020-04694-8) contains supplementary material, which is available to authorized users. * Sravya Challa [email protected]
1
Harvard Combined Orthopaedic Residency Program, Boston, MA, USA
2
UCSF Department of Orthopedic Surgery, Institute for Global Orthopaedics and Traumatology, San Francisco, CA, USA
3
Paul Levy [email protected]
Harvard Global Orthopaedics Collaborative, Harvard Combined Orthopaedic Residency Program, Boston, MA, USA
4
Jill Barr-Walker [email protected]
Department of Orthopaedic Surgery, The Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women’s Hospital, Boston, MA, USA
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