Purpose

The timing of treatment for Gartland type III supracondylar fractures has been an area of contention as it was previously thought to be a surgical emergency. The aim of this systematic review and meta-analysis is to clarify whether there is a difference in perioperative outcomes between early and delayed treatment for Gartland type III supracondylar humeral fractures in children.

Methods

Literature search and study selection were performed according to the PRISMA process. The early surgery (ES) and delayed surgery (DS) groups were defined by the authors of each study included, based on the time to surgery. The primary outcome was the risk of conversion to open reduction. The secondary outcome was perioperative complication risks.

Results

A total of 14 studies met the eligibility criteria (n = 1263 patients), of which 665 (52.7%) patients had undergone early surgery, while 598 (47.3%) had delayed surgery. On meta-analysis, there was no significant difference between ES and DS for the outcome of open reduction conversion risk. There was also no significant difference for the secondary outcomes of post-operative compartment syndrome, iatrogenic nerve injury, vascular injury, and surgical site infection.

Conclusion

Despite the limitations in the literature, evidence exists to support the notion that a delayed approach to the surgical treatment of Gartland type III supracondylar humeral fractures in children does not result in an increased risk of converting to open reduction and perioperative complications.

中文翻译：

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儿童 Gartland III 型肱骨髁上骨折的早期与延迟治疗：系统评价和荟萃分析

目的

Gartland III 型髁上骨折的治疗时机一直存在争议，因为它以前被认为是外科急症。本系统评价和荟萃分析的目的是阐明早期和延迟治疗儿童 Gartland III 型肱骨髁上骨折的围手术期结局是否存在差异。

方法

根据 PRISMA 流程进行文献检索和研究选择。早期手术 (ES) 和延迟手术 (DS) 组由每项研究的作者根据手术时间定义。主要结果是转为切开复位的风险。次要结局是围手术期并发症风险。

结果

共有14项研究符合纳入标准（n  = 1263例患者），其中665例（52.7%）患者接受了早期手术，598例（47.3%）患者延迟了手术。在荟萃分析中，ES 和 DS 对切开还原转换风险的结果没有显着差异。术后隔室综合征、医源性神经损伤、血管损伤和手术部位感染的次要结局也没有显着差异。

结论

尽管文献存在局限性，但仍有证据支持这样一种观点，即延迟手术治疗儿童 Gartland III 型肱骨髁上骨折不会增加转为切开复位和围手术期并发症的风险。