RESUMO
INTRODUCTION: This study aimed to report the proportion of children requiring subsequent surgical intervention, rate of complications and radiologic outcomes following collar and cuff immobilisation with high elbow flexion (>90°) for Gartland type II supracondylar fractures. METHODS: A retrospective case series of consecutive patients aged <18 years with Gartland type II fractures treated at a level 1 trauma centre from December 2020 to April 2023 was conducted. The need for surgical intervention and complications were recorded from electronic clinical notes. The initial, post-immobilisation and final Baumann's angle and lateral humeral-capitellar angle (LHCA) were measured and compared. RESULTS: In total, 42 patients were included in this study. Thirty-four were treated definitively in a collar and cuff with a mean elbow flexion of 109.4°. Two patients underwent closed reduction and Kirschner wire fixation. No patient required subsequent corrective osteotomy. There were no cases of recorded complications. Immobilisation in a collar and cuff with >90° elbow flexion was associated with a significant improvement in the mean LHCA (initial 80.9° vs final 65.6°, p < 0.001). There was no significant change in the LHCA post immobilisation in a collar and cuff until final radiographic follow-up (post immobilisation 68.3° vs final 65.6°, p=0.274). CONCLUSIONS: Immobilisation in a collar and cuff with high elbow flexion is a safe and effective nonoperative treatment method to reduce and immobilise Gartland type II supracondylar fractures. Surgical treatment could be reserved for cases with unsatisfactory alignment or early loss of reduction following attempted nonoperative treatment.
RESUMO
INTRODUCTION: The British Orthopaedic Association published 2019 guidelines 'The Older or Frail Orthopaedic Trauma Patient'. This implements principles of the hip fracture pathway to all fragility fractures. Like hip fractures, femoral shaft fractures in the elderly are also suggested to represent fragility fractures. Femoral shaft fractures in older patients are rare and there is scarce literature detailing their outcomes. We aim to review outcomes of femoral shaft fractures in patients age 60 years and over at our institution and compare them to that of the hip fracture population. MATERIALS AND METHODS: We retrospectively reviewed clinical records of a consecutive cohort of patients aged 60 years and over, who sustained a femoral shaft fracture, over a five-year period at our institution. Outcome measures studied were time to surgery, mean length of admission, readmission rate within 30 days, medical and orthopaedic complications, one month and one year mortality. RESULTS: We identified 53 patients with a mean age of 78.7 years. On average patients each had 2.7 medical comorbidities. Mean length of admission was 20.0 days and readmission rate within 30 days was 19.1% (n=9). Medical complications affected 41.5% of patients (n=22) and orthopaedic complications affected 9.4% of patients (n=5). Two patients demonstrated nonunion and one patient required revision surgery. Thirty day mortality rate was 13.2% (n=7) which increased to a one year mortality of 26.4% (n=14). CONCLUSION: Patients age 60 years and over with femoral shaft fractures have poor medical outcomes and prolonged length of admission. Compared to patients with hip fractures, medical complication rates are at least twice the 13-20% reported for hip fractures. The 30 day mortality rate in patients with femoral shaft fractures was also more than double the 6.1% reported for hip fracture patients by The National Hip Fracture Database in 2018. Femoral shaft fractures are associated with high medical morbidity and mortality. The hip fracture pathway is encompassed in the British Orthopaedic Association guidelines and emphasizes early medical input and a multidisciplinary approach to patient management. Hence, our study supports implementation of these guidelines with aim to improve morbidity and mortality of this vulnerable patient group.