Title

Variation Among Pediatric Orthopaedic Surgeons When Treating Medial Epicondyle Fractures.

Document Type

Article

Publication Date

9-2019

Identifier

DOI: 10.1097/BPO.0000000000001092

Abstract

Background: Medial epicondyle fractures are a common pediatric and adolescent injury accounting for 11% to 20% of elbow fractures in this population. This purpose of this study was to determine the variability among pediatric orthopaedic surgeons when treating pediatric medial epicondyle fractures.

Methods: A discrete choice experiment was conducted to determine which patient and injury attributes influence the management of medial epicondyle fractures by pediatric orthopaedic surgeons. A convenience sample of 13 pediatric orthopaedic surgeons reviewed 60 case vignettes of medial epicondyle fractures that included elbow radiographs and patient/injury characteristics. Displacement was incorporated into the study model as a fixed effect. Surgeons were queried if they would treat the injury with immobilization alone or open reduction and internal fixation (ORIF). Statistical analysis was performed using a mixed effect regression model. In addition, surgeons filled out a demographic questionnaire and a risk assessment to determine if these factors affected clinical decision-making.

Results: Elbow dislocation and fracture displacement were the only attributes that significantly influenced surgeons to perform surgery (P<0.05). The presence of an elbow dislocation had the largest impact on surgeons when choosing operative care (β=-0.14; P=0.02). In addition, for every 1 mm increase in displacement, surgeons tended to favor ORIF by a factor of 0.09 (P<0.01). Sex, mechanism of injury, and sport participation did not influence decision-making. In total, 54% of the surgeons demonstrated a preference for ORIF for the included scenarios. On the basis of the personality Likert scale, participants were neither high-risk takers nor extremely risk adverse with an average-risk score of 2.24. Participant demographics did not influence decision-making.

Conclusions: There is substantial variation among pediatric orthopaedic surgeons when treating medial epicondyle fractures. The decision to operate is significantly based on the degree of fracture displacement and if there is a concomitant elbow dislocation. There is no standardization regarding how to treat medial epicondyle fractures and better treatment algorithms are needed to provide better patient outcomes.

Level of evidence: Level V.

Journal Title

Journal of pediatric orthopedics

Volume

39

Issue

8

First Page

592

Last Page

592

MeSH Keywords

Adult; Child, Preschool; Clinical Decision-Making; Elbow Joint; Female; Fracture Fixation, Internal; Humans; Humeral Fractures; Immobilization; Joint Dislocations; Male; Middle Aged; Open Fracture Reduction; Orthopedics; Pediatrics; Practice Patterns, Physicians'; Radiography; Treatment Outcome

Keywords

Adult; Child, Preschool; Clinical Decision-Making; Elbow Joint; Female; Fracture Fixation, Internal; Humans; Humeral Fractures; Immobilization; Joint Dislocations; Male; Middle Aged; Open Fracture Reduction; Orthopedics; Pediatrics; Practice Patterns, Physicians'; Radiography; Treatment Outcome

Share

COinS