Preoperative 'target marking' on the skin reduces radiation exposure and total surgical duration in surgically treated pediatric supracondylar humerus fractures; a case-control clinical study.

Abstract

Background: Primary treatment for supracondylar humerus fractures SCHF involves a closed reduction and fixation with K-wires. The aim of this study is to investigate whether a target marking of the humerus is effective in reducing operation duration and radiation exposure in surgically treated pediatric supracondylar humerus fractures.

Methods: Patients treated with a closed reduction and percutaneous pinning (CRPP) for a SCHF between 2019 and 2023 were included. The study data was evaluated into two groups; Group 1 with patients who underwent closed reduction followed by outlining the boundaries of the humerus on the skin and subsequent fixation with K-wires (target marking group), while Group 2 patients underwent closed reduction without outlining (unmarked group). The same K-wire configuration, consisting of 2 lateral and 1 medial crossed pinning, was utilized. Operation duration and the radiation dose received (millisievert) were recorded for each patient and compared in-between.

Results: Overall surgical duration was significantly shorter in Group 1 (p < 0.001). A significantly lower radiation dose was required in patients of Group 1 to achieve a satisfactory reduction for both fracture types and for the overall patient cohort (p < 0.001).

Conclusions: Enhancing the three-dimensional perception of the surgeon in pediatric supracondylar humerus fractures treated with closed reduction and percutaneous pinning resulted in a reduction of both the operative duration and the radiation dose. A novel method of 'target marking' showed a significant reduction in surgical duration and the amount of radiation exposure.