“These are very serious injuries requiring appropriate evaluation and treatment,” said James Sanders, MD, chair of the AAOS AUC for the Management of Pediatric Supracondylar Humerus Fractures work group. “These criteria will be helpful for clinicians who treat these injuries on an occasional basis.”
The AAOS AUCs provides clinicians with algorithms on how to optimally treat an orthopaedic injury or condition, including hypothetical scenarios and possible treatments, ranked for appropriateness based on the latest research and clinical expertise and experience.
Supracondylar humerus fractures occur at or near the elbow, and account for 10 percent of all fractures in children. These injuries often occur when a child extends his or her arm to break a fall, resulting in severe pain and numbness in the elbow, forearm or hand. The treatment of these injuries depends on the location and severity of the break, whether or not the bone is displaced (misaligned) or fragmented, the child’s age, and whether or not the break is at a near the growth plate (the end of the bone where growth occurs).
Optimal treatment may require the surgical placement of a pin to hold the realigned bones, while protecting the surrounding nerves and blood vessels, or nonsurgical treatment with a cast or splint. When not treated correctly, these injuries can result in deformity, limited range of motion and the need for additional surgery.
The app, a specialized program which can be accessed from any computer web browser, tablet or mobile device, has three sections. The first section provides a list of “assumptions” or considerations for ensuring that the hospital and staff have the knowledge and capabilities to successfully treat a pediatric supracondylar humerus fracture. They include whether:
- The patient is healthy enough to undergo surgery, if needed.
- A thorough history and physical examination of the patient has been conducted.
- Adequate radiographs (imaging) have been obtained and examined.
- The surgeon who cares for the child can perform the appropriate orthopaedic procedures.
- The surgery will be performed in a timely fashion, in an appropriate location.
- The facility has proper implants, ancillary equipment, and capable support personnel.
“It helps them to ask, ‘should we be treating this child, or should the child be transferred to another hospital?’” said Dr. Sanders.
Once the user has agreed that the “assumptions” are understood and met, they are linked to nearly 3,200 possible patient injury scenarios. The user identifies the correct scenario, and the app shows the related treatments ranked for their appropriateness, “helping to ensure optimal care and the best long-term outcome for resuming functional use of the elbow,” said Dr. Sanders.
Read the full AUC.
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