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Supracondylar humerus fractures in low- and lower middle-income countries: a scoping review of the current epidemiology, treatment modalities, and outcomes

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Abstract

Background

The purpose of this scoping review was to examine the nature and quality of research regarding paediatric supracondylar humerus (SCH) fractures in low and lower middle-income countries (LICs).

Methods

We searched PubMed, Embase, Web of Science, and African Journals Online on January 9, 2018, for studies of SCH fractures in LICs. Studies were categorized by geographic region, Gartland classification of included patients, and study design. We evaluated each study’s methodology and conclusions.

Results

Out of 1805 results, we analyzed 105 studies, most of which included type 3 fractures only (66%). Many were conducted in South Asia (58%) and assessed treatment outcomes (78%). Most of the studies had level IV evidence (67%). Common limitations of research were small sample size (12%) and inadequate follow-up (6%). Epidemiological studies concluded that SCH fractures are more common among male children, are usually secondary to falls, and rarely present with nerve injuries. Most therapeutic studies reported outcomes of surgery (91%). Thirteen studies concluded that all-lateral versus cross-pinning techniques have similar outcomes. Seven studies reported preference for closed reduction over open reduction, when intra-operative fluoroscopy was available. Most common outcome measures were Flynn criteria (77%) and range of motion (53%). None of the papers looked at treatment costs.

Conclusions

Our data show a predominance of small level IV studies from LICs, with few studies of higher level of evidence. Many studies examined controversies with surgical technique, similar to studies performed in high-income countries. Few studies examined non-operative treatment, which is commonly the predominant treatment available for patients in LICs. Further investigation of common treatment modalities and outcomes for SCH fractures in LICs is needed.

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Acknowledgments

Thank you to Evans Whitaker, UCSF Library, for peer reviewing our search.

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Authors and Affiliations

  1. Harvard Combined Orthopaedic Residency Program, Boston, MA, USA

    Sravya Challa

  2. UCSF Department of Orthopedic Surgery, Institute for Global Orthopaedics and Traumatology, San Francisco, CA, USA

    Sravya Challa, Paul Levy & Coleen S. Sabatini

  3. Harvard Global Orthopaedics Collaborative, Harvard Combined Orthopaedic Residency Program, Boston, MA, USA

    Kiran J. Agarwal-Harding

  4. Department of Orthopaedic Surgery, The Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women’s Hospital, Boston, MA, USA

    Kiran J. Agarwal-Harding

  5. Zuckerberg San Francisco General Library, University of California, San Francisco, San Francisco, CA, USA

    Jill Barr-Walker

  6. UCSF Benioff Children’s Hospital Oakland, Oakland, CA, USA

    Coleen S. Sabatini

Authors
  1. Sravya Challa
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  2. Kiran J. Agarwal-Harding
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  3. Paul Levy
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  4. Jill Barr-Walker
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  5. Coleen S. Sabatini
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Sravya Challa, Kiran Agarwal-Harding, Paul Levy, Jill Barr-Walker, and Coleen Sabatini. The first draft of the manuscript was written by Sravya Challa and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Sravya Challa.

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The authors declare that they have no conflict of interest.

Ethics approval

This study is a systematic review and therefore exempt from IRB review.

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Electronic supplementary material

ESM 1

PRISMA ScR checklist. (DOCX 31 kb).

ESM 2

PRISMA-S checklist. (DOCX 48 kb).

ESM 3

Search strategy details. All searches were conducted on January 9, 2018. (DOCX 14 kb).

ESM 4

List of World Bank “Low income” and “Low-middle income” countries (DOCX 14 kb).

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Challa, S., Agarwal-Harding, K.J., Levy, P. et al. Supracondylar humerus fractures in low- and lower middle-income countries: a scoping review of the current epidemiology, treatment modalities, and outcomes. International Orthopaedics (SICOT) 44, 2443–2448 (2020). https://doi.org/10.1007/s00264-020-04694-8

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  • DOI: https://doi.org/10.1007/s00264-020-04694-8

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