Variation Among Pediatric Orthopaedic Surgeons When Treating Medial Epicondyle Fractures. Issue 8 (September 2019)

• Record Type: Journal Article
• Authors: Hughes, Meghan; Dua, Karan; O'Hara, Nathan N.; Brighton, Brian K.; Ganley, Theodore J.; Hennrikus, William L.; Herman, Martin J.; Hyman, Joshua E.; Lawrence, J. Todd; Mehlman, Charles T.; Noonan, Kenneth J.; Otsuka, Norman Y.; Schwend, Richard M.; Shrader, M. Wade; Smith, Brian G.; Sponseller, Paul D.; Abzug, Joshua M.
• Is Part Of: Journal of pediatric orthopaedics. Volume 39:Issue 8(2019)
• Publication Date: 2019-09
• Subjects: medial epicondyle -- fracture -- pediatric -- discrete choice experiment -- variation -- treatment; Pediatric orthopedics -- Periodicals; 618.927
• DOI: 10.1097/BPO.0000000000001092
• Languages: English
• ISSNs: 0271-6798

Abstract

Abstract : Background: Medial epicondyle fractures are a common pediatric and adolescent injury accounting for 11% to 20% of elbow fractures in this population. This purpose of this study was to determine the variability among pediatric orthopaedic surgeons when treating pediatric medial epicondyle fractures. Methods: A discrete choice experiment was conducted to determine which patient and injury attributes influence the management of medial epicondyle fractures by pediatric orthopaedic surgeons. A convenience sample of 13 pediatric orthopaedic surgeons reviewed 60 case vignettes of medial epicondyle fractures that included elbow radiographs and patient/injury characteristics. Displacement was incorporated into the study model as a fixed effect. Surgeons were queried if they would treat the injury with immobilization alone or open reduction and internal fixation (ORIF). Statistical analysis was performed using a mixed effect regression model. In addition, surgeons filled out a demographic questionnaire and a risk assessment to determine if these factors affected clinical decision-making. Results: Elbow dislocation and fracture displacement were the only attributes that significantly influenced surgeons to perform surgery ( P <0.05). The presence of an elbow dislocation had the largest impact on surgeons when choosing operative care (β=−0.14; P =0.02). In addition, for every 1 mm increase in displacement, surgeons tended to favor ORIF by a factor of 0.09 ( P <0.01). Sex, mechanism of injury, and sport participation did not influence decision-making. In total, 54% of the surgeons demonstrated a preference for ORIF for the included scenarios. On the basis of the personality Likert scale, participants were neither high-risk takers nor extremely risk adverse with an average-risk score of 2.24. Participant demographics did not influence decision-making. Conclusions: There is substantial variation among pediatric orthopaedic surgeons when treating medial epicondyle fractures. The decision to operate is significantly based on the degree of fracture displacement and if there is a concomitant elbow dislocation. There is no standardization regarding how to treat medial epicondyle fractures and better treatment algorithms are needed to provide better patient outcomes. Level of Evidence: Level V.