Surgeon factor in pediatric supracondylar humerus fractures

Özet

The surgeon and the surgical approach of the clinic where the surgeon was trained may have an impact on perioperative outcomes. In this study, among the surgeons with similar surgical experiences, we aimed to investigate the association of open-closed reduction rates, postoperative sagittal, coronal and axial plan deformities, and prefer-ence of open surgical approaches to surgeons and the clinics they were trained. We evaluated 90 cases retrospectively who underwent surgery upon diagnosis of Gartland type 3 pediatric supracondylar humerus fractures associated with extension deformity. Those whose surgery was performed after 24 hours, or patients with open fractures, flexion type supracondylar fractures, non-Gartland type 3 supracondylar fractures, fractures with neurovascular deficits, multiple comminuted fractures, pathologic frac-tures, or additional injury and fractures were not included to the study. All the surgeons who had >5 years of surgical experience as a specialist and >15 of pediatric elbow fracture surgery as an operator (n=12) were numbered between 1 and 12. The clinics of these surgeons were classified from A to F (n=6). Data on patients’ age, gender, duration of surgery, follow-up time, postoperative sagittal, coronal angulation, postoperative rotational deformity, operation time, rates of open-closed surgery, the surgical approach in those open surgery was performed, the number and characteristics of the pins used were collected to analyze in relation with their assigned surgeons and the clinics they were trained. Among the 90 cases, 54 (59.3%) were male patients. The mean age was 6.21±3.03 years. There was no significant difference between the clinics in terms of sagittal and rotational deformities and open reduction rates (p>0.05). The clinics significantly differed in preference of the side of incisions (medial, lateral, posterior), (p<0.05). The number of pins, Baumann, and lateral humerocapitellar angles was similar between the clinics. The mean duration of the surgery (41.54±17.02 min) of the surgeons from the F clinic was lower than that of the other clinics (p: 0.004). In open surgeries, there was not a significant difference between surgeons in terms of single or double incision and side of the incision (medial, lateral, posterior) (p: 0.094). The number of pins also significantly differed among surgeons (p: 0.009). The type of surgical approach and treatment modality in pediatric supracondylar fractures is at the surgeon’s discretion and therefore may be influenced by the approach of the clinic where the surgeon had specialty training. Nevertheless, within-clinic variations might also occur depending on the surgeon’s preference or their role model advisor. Individual preferences may result in differences in operative time and case-specific complication rates.