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
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
Recommended Citation
Hughes M, Dua K, O'Hara NN, et al. Variation Among Pediatric Orthopaedic Surgeons When Treating Medial Epicondyle Fractures. J Pediatr Orthop. 2019;39(8):e592-e596. doi:10.1097/BPO.0000000000001092
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