Are we staying up too late? Timing of surgery of displaced supracondylar fractures in children. Clinical audit in a paediatric tertiary UK trauma centre and literature review

Introduction The British Orthopaedic Association (BOA) guidelines in managing supracondylar humerus fractures in children, outline indications for urgent fixation of these fractures. We present our data from a regional paediatric trauma centre before and after implementing a change in practice as per these guidelines. Materials and methods Retrospective clinical audit against BOA guidelines. Radiographs, admission clerking notes, operation notes, and clinic letters were all reviewed. We included all displaced supracondylar fractures of the extension type (Gartland Types 2b and 3). The first audit cycle occurred in 2017, subsequent cycles in 2018 & 2019. Results 172 patients reviewed across the three audit stages. In the first audit, almost quarter of patients were operated on in the same night without clear indication as per the guidelines. This dropped down to 7% after a change of practice in 2019. Rate of conversion to open reduction and nerve complications did not increase after delayed fixation. Conclusion When there is no indication for same night operating out of hours, delaying treatment until the next day seems to be a safe way of treating these difficult fractures. Our data show that there is no increase in complications when these fractures are managed the next day.