Citation

Vallila N, Sommarhem A, Paavola M, Nietosvaara Y. J. Bone Joint Surg. Am. 2015; 97(6): 494-499.

Affiliation

Children's Hospital, Helsinki University Central Hospital, Stenbäckinkatu 11, P.O. Box 281, FIN-00029 HUS Helsinki, Finland. E-mail address for A. Sommarhem: antti.sommarhem@hus.fi. E-mail address for Y. Nietosvaara: yrjana.nietosvaara@hus.fi.

Copyright

(Copyright © 2015, Journal of Bone and Joint Surgery)

DOI

10.2106/JBJS.N.00758

PMID

25788306

Abstract

BACKGROUND: The distal part of the humerus is the second most common fracture location in children. Complications are more common than with other pediatric fractures and are mostly related to inappropriate diagnosis and treatment.

METHODS: On the basis of data from 1990 through 2010 in the national registry of inpatient care treatment in Finland, we calculated the number of children less than seventeen years of age who were treated under anesthesia for a distal humeral fracture (reduction with or without internal fixation) and the number of treatment institutions. We analyzed compensation claims concerning the treatment of these fractures that were received by the Patient Insurance Centre. The risk of a complication of treatment and the number of avoidable complications of treatment were assessed.

RESULTS: A total of 7909 children underwent a procedure under anesthesia to treat a distal humeral fracture. Claims were filed for 117 patients (118 fractures, including seventy-four supracondylar, nineteen epicondylar, nineteen condylar, and six T-type), and compensation was granted for eighty-three (71%) of the patients. Deformity (forty-nine), delayed treatment (twenty), nerve injury (seventeen), and infection (seven) were the most common reasons for compensation. On reevaluation of the claims, ninety patients were assessed as having had complications of treatment. In our opinion, complications could have been avoided for eighty-six (96%) of these patients.

CONCLUSIONS: We believe that improving the quality of primary assessment and operative technique would decrease the number of complications in the treatment of pediatric distal humeral fractures. Centralizing operative treatment to tertiary hospitals should be considered. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Language: en