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Trauma: P. J. Walmsley, M. B. Kelly, J. E. Robb, I. H. Annan, and D. E. Porter Delay increases the need for open reduction of type-III supracondylar fractures of the humerus J Bone Joint Surg Br 2006; 88-B: 528-530 [Abstract] [Full text] [PDF]

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Delay increases the need for open reduction of type-III supracondylar fractures of the humerus

S THOMAS   (15 May 2006)

Delay increases the need for open reduction of type-III supracondylar fractures of the humerus 15 May 2006
S THOMAS, CLINICAL FELLOW NORTH TYNESIDE HOSPITAL, NORTH SHIELDS,TYNE AND WEAR, UK. Send letter to journal: Re: Delay increases the need for open reduction of type-III supracondylar fractures of the humerus thomassuresh{at}rediffmail.com S THOMAS	Sir, This article has been read with great interest. While commending the authors' effort in assessing this topic which is currently being debated, I would like to highlight a few points which could have affected the outcome of this study. 1. Dividing the patients into two groups based on the time of arrival in the accident and emergency department will not give the correct interval between the injury and surgery. This is particularly important in district general hospitals like ours, where similar cases are often brought to the accident and emergency department from the periphery of the catchment area with an existing time delay following the injury. The authors have made an attempt to look into the ambulance charts but more reliable information about the time of injury could have been obtained from the family/carers, especially when a severe injury to the elbow has occurred. 2. The authors do not state clearly if the time of presentation and time of surgery were associated with a higher rate of open reduction. There could be more chance of open reduction being performed if the cases were done during normal working hours with a fully-equipped theatre and back-up facilities. 3. The authors do not highlight if there was a difference in the rate of open reduction between the treating teams. This series was operated on, or supervised by different consultants, and personal preferences and experiences could have affected the rate of open reduction. 1. Mangwani J, Nadarajah R, Paterson JMH. Supracondylar humeral fractures in children - ten years' experience in a teaching hospital. J Bone and Joint Surg [Br] 2006;88-B:362-5. 2. Sibinski M, Sharma H, Bennet GC. Early versus delayed treatment of extension type-3 supracondylar fractures of the humerus in children. J Bone Joint Surg [Br] 2006;88-B:380-1.