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Variation Among Pediatric Orthopaedic Surgeons When Treating Medial Epicondyle Fractures
Journal article   Peer reviewed

Variation Among Pediatric Orthopaedic Surgeons When Treating Medial Epicondyle Fractures

Meghan Hughes, Karan Dua, Nathan N. O'Hara, Brian K. Brighton, Theodore J. Ganley, William L. Hennrikus, Martin J. Herman, Joshua E. Hyman, J. Todd Lawrence, Charles T. Mehlman, …
Journal of pediatric orthopaedics, v 39(8), pp E592-E596
01 Sep 2019
DOI: https://doi.org/10.1097/BPO.0000000000001092
PMID: 31393295
Featured in Collection :   UN Sustainable Development Goals @ Drexel

Abstract

Life Sciences & Biomedicine Orthopedics Pediatrics Science & Technology
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 (beta=-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.

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23 citations in Web of Science
28 citations in Scopus

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Collaboration types
Domestic collaboration
Web of Science research areas
Orthopedics
Pediatrics
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