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European Journal of Trauma and Emergency Surgery

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25-08-2020 | Elastic-Stable Intramedullary Nailing | Original Article

Timing of osteosynthesis of fractures in children changes the outcome

Authors: Danielle S. Wendling-Keim, Marion Binder, Hans-Georg Dietz, Markus Lehner

Published in: European Journal of Trauma and Emergency Surgery | Issue 5/2022

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.

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Title: Timing of osteosynthesis of fractures in children changes the outcome
Authors: Danielle S. Wendling-Keim
Marion Binder
Hans-Georg Dietz
Markus Lehner
Publication date: 25-08-2020
Publisher: Springer Berlin Heidelberg
Keyword: Elastic-Stable Intramedullary Nailing
Published in: European Journal of Trauma and Emergency Surgery / Issue 5/2022
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI: https://doi.org/10.1007/s00068-020-01464-4

At a glance: The STEP trials

Springer Medicine

Timing of osteosynthesis of fractures in children changes the outcome

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

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