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Crppf supracondylar fracture12/6/2023 ![]() Preoperative radiographs were evaluated for 4 factors. Our aim was to determine whether 1) radiographic parameters commonly used in the evaluation of SCH fracture and subsequent fracture reduction, and 2) arm appearance at mid-term follow-up were associated with mid-term functional outcomes according to validated PRO measures. To our knowledge, no study has investigated associations between mid-term PROMIS and QuickDASH scores and pre- and postoperative radiographic parameters in pediatric SCH fractures. It has been used to assess outcomes in pediatric SCH fractures, suggesting that excellent functional results are achieved regardless of neurological complications, direction of fracture displacement, and Gartland classification. The QuickDASH is a concise measure of physical function and symptoms in patients with musculoskeletal disorders of the upper extremities. PROMIS has been used to assess outcomes in several orthopedic conditions, including those of the foot and ankle, upper extremity, and spine, but not in SCH fractures. The Patient-Reported Outcomes Measurement Information System (PROMIS) is widely available, precise, reliable, and broad in scope. PRO measures are patient-centered metrics of satisfaction and success. Furthermore, despite the widespread use of radiographic criteria to determine the need for fracture reduction and evaluate the postoperative quality of reduction, little is known about associations between these criteria and long-term PROs. Few studies have investigated outcomes of surgical treatment of SCH fractures using validated patient-reported outcome (PRO) measures. Supracondylar humeral (SCH) fractures are the most common elbow fractures in children, with an annual incidence of approximately 70 fractures per 100,000 children. Radiographic parameters that are used to evaluate the need for and quality of pediatric SCH fracture reduction are not significantly associated with mid-term PROMIS and QuickDASH scores. There was no association between fractured arm appearance at follow-up and PRO scores. No other preoperative or postoperative radiographic parameter was significantly associated with PRO scores. It is unknown if this statistical difference translates to clinical relevance. Patients with Gartland type-III fractures had significantly greater disability on the QuickDASH at follow-up compared with those with Gartland type-II fractures ( P < .01). Bivariate analysis was used to determine whether radiographic parameters and arm appearance were associated with QuickDASH and PROMIS scores. Anterior humeral line through the capitellum, Baumann angle in the 7.5th to 92.5th percentile of the sample, or rotation ratio between 0.85 and 1.15 were considered near complete/complete reductions all others were considered incomplete. We evaluated postoperative radiographs for coronal/sagittal deformity, Baumann angle, and rotation and classified reductions as near complete/complete or incomplete. Parents were also asked whether the previously fractured arm appeared normal or abnormal. Patients, parents were asked via telephone to complete the QuickDASH (Quick Disability of the Arm, Shoulder, and Hand) and PROMIS (Patient-Reported Outcomes Measurement Information System) Strength Impact, Upper Extremity, and Pain Interference questionnaires. We evaluated preoperative radiographs for coronal/sagittal fracture displacement, presence of impaction/comminution, Gartland classification, and rotation. ![]() Mean time from initial treatment to outcome survey completion was 5.0 ± 2.1 years (range, 2.0–10 years). Mean (± standard deviation) age at surgery was 5.1 ± 2.1 years. We retrospectively reviewed data from 213 patients (104 girls) treated surgically for Gartland type-II (n = 84) or type-III (n = 129) SCH fractures from 2008–2016. We studied whether such parameters are correlated with mid-term patient-reported outcome (PRO) scores in pediatric patients. Radiographic parameters are commonly used to determine the need for surgical supracondylar humeral (SCH) fracture reduction and the postoperative quality of reduction. ![]()
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