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AAOS issues new clinical practice guideline for treatment of pediatric elbow fractures
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The American Academy of Orthopaedic Surgeons Board of Directors approved and released an evidence-based clinical practice guideline for treatment of supracondylar humerus fractures in pediatric patients.
The clinical practice guideline was constructed by a work group under the leadership of Andrew Howard, MD, a pediatric orthopedic surgeon and medical director of the trauma program at the University of Toronto Hospital for Sick Children.
The guideline, according to an American Academy of Orthopaedic Surgeons (AAOS) release, is the result of a review of more than 350 research studies on the topic. It includes 14 recommendations on the stabilization of these fractures, as well as treatment of circulation issues.
Stabilization of these fractures, according to the guideline, should first be achieved through “two or three laterally introduced pins to stabilize the reduction of displaced, misaligned, supracondylar fractures of the humerus.”
Other recommendations in the guideline include procedures designed to restore blood flow and circulation in cases where the artery has been stretched, torn or severed. The AAOS release noted that circulation is likely to recover once the fracture is put back into its proper position and established.
In cases where there is still no pulse in the arm following realignment, the guideline recommends surgical exploration of the blood vessels and nerves in front of the elbow in patients with no wrist pulse. According to the release, this should be performed in cases where the hand remains cold and underperfused, specifically to ensure tissue survival in the arm and hand. Further surgery may be necessary in these cases, the guideline added, “to prevent rare, but serious, limb threatening and life threatening consequenes.”
“If the hand feels warm, has color from circulation that you can see, and the child can move the muscles of the forearm and demonstrate some motion, then there is evidence that tissues are being nourished despite the absent pulse,” the authors of the guideline noted, adding that surgery or observation are not specifically recommended in these cases.
“Ultimately, each physician must evaluate his or her patient’s condition and circumstance and figure out, ‘How do I best treat this child?’” Howard stated in the release.
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