Timing of osteosynthesis of fractures in children changes the outcome
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ORIGINAL ARTICLE
Timing of osteosynthesis of fractures in children changes the outcome Danielle S. Wendling‑Keim1 · Marion Binder1 · Hans‑Georg Dietz1 · Markus Lehner1,2,3 Received: 7 February 2020 / Accepted: 13 August 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose The search for optimal treatment strategies for fractures in children that require osteosynthesis is controversial and is still being debated. A major factor that has been under discussion is the impact of the timing of surgery: the time delay between the trauma and the operation, as well as the duration of the surgical procedure, and the time of day that the operation is performed are potential factors that might influence the outcome. Therefore, the aim of our study was to investigate the influence of these factors on the outcome after osteosynthesis of diverse fractures of the extremities in children. Methods In a retrospective study, 387 patients aged 1–18 years who presented with fractures of the extremities that underwent surgery were included. Patient records including radiological studies were analyzed. The follow up period lasted at least 12 months or until recovery. Statistical significance was set at an alpha level of P ≤ 0.05. Results Delayed surgery, as well as a prolonged duration of surgery, and the mode of transportation of the patient significantly were related to a higher rate of complications. However, in this study, the complication rate was not found to be influenced by the mode of reduction of the fracture, or the time of day or the day of the week. A further parameter that significantly changed the outcome was the mechanism of injury. However, the rate of complications was unchanged if a resident or a consulting was the performing surgeon so that a resident can safely perform the procedure in the presence of a consultant. Conclusion Timing of surgery for fractures of the extremities in children, including the time from trauma to surgery, the duration of the operation and the mode of transportation to the ER, were found to have a significant impact on the occurrence of complications in this study while the mode of reduction and the time of day did not change the outcome. Future studies with a focus on selected types of fractures are needed to further enlighten this topic. Level of evidence Retrospective comparative study, level III. Keywords Fractures of the extremities in children · Elastic stable intramedullary nailing (ESIN) · Kirschner wire fixation · Complication · Screw fixation · Timing · Complications of osteosynthesis
Introduction The timing of surgical treatment of fractures in children remains the subject of controversy to date. The impact of delaying surgical treatment has been studied previously and the results do not support any definite recommendations [1–4]. For example, one retrospective study recommends the delay of surgery for supracondylar fractures of the * Danielle S. Wendling‑Keim [email protected] 1
Pediatric Surgery, Dr. von Hauner Childrens’ Hospit
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