Article Figures & Tables
Figures
- Figure 1
Flow chart showing selection of study patients. GTA = Greater Toronto Area, SCH = supracondylar humerus. Numbers eligible for study inclusion do not equal total numbers less numbers excluded because exclusions were not sequential (there were overlaps between "complicated fracture", "age >14" and "outside GTA").
- Figure 2
Population-standardized number of supracondylar humerus (left) and femur (right) fractures in the Greater Toronto Area (GTA), 2008/09 to 2014/15. Number standardized to 2011 GTA population aged 14 years or less. Numbers within regions indicate Local Health Integrated Networks (LHINs). Patients presenting from geographic areas outside the GTA LHINs were excluded from all analyses.
- Figure 3
Proportion of supracondylar humerus fractures in 2002 versus 2015 treated at The Hospital for Sick Children, other specialized pediatric centres and community hospitals.
- Figure 4
Population-standardized annual incidence rates of uncomplicated supracondylar humerus and femur fractures, 2008/09 to 2014/15, by patient subgroup. Rates standardized to the Greater Toronto Area population aged 14 years or less in 2011.
Tables
- Table 1: Baseline characteristics of patients who underwent surgery at The Hospital for Sick Children for supracondylar humerus fracture
Characteristic Year; no. (%) of patients* (n = 945) p value for trend 2008/09
(n = 108)2009/10
(n = 113)2010/11
(n = 101)2011/12
(n = 158)2012/13
(n = 150)2013/14
(n = 146)2014/15
(n = 169)Missing Demographic Age, mean ± SD, yr 5.44 ± 2.47 5.20 ± 2.54 5.66 ± 2.78 5.35 ± 2.42 5.53 ± 2.55 5.51 ± 2.50 5.43 ± 2.47 0 (0) 0.7 Female sex 56 (51.9) 64 (56.6) 39 (39.4) 68 (43.6) 63 (42.0) 70 (48.0) 86 (50.9) 4 (0.4) 0.6 American Society of Anesthesiologists score 30 (3.2) 0.3 -1 86 (86.9) 96 (90.6) 85 (87.6) 136 (88.3) 129 (87.8) 128 (87.7) 154 (92.8) -2 11 (11.1) 9 (8.5) 11 (11.3) 16 (10.4) 17 (11.6) 16 (11.0) 10 (6.0) -3 2 (2.0) 1 (0.9) 1 (1.0) 2 (1.3) 1 (0.7) 2 (1.4) 2 (1.2) Presence of any comorbidity 0 (0) 0 (0) 2 (2.0) 3 (1.9) 0 7 (4.8) 5 (3.0) 0 (0) 0.007 Injury Gartland type III/IV 73 (71.6) 67 (60.4) 58 (57.4) 100 (64.1) 89 (59.3) 96 (65.8) 105 (62.5) 11 (1.2) 0.6 Open fracture 3 (2.8) 1 (0.9) 1 (1.0) 4 (2.6) 2 (1.4) 0 (0) 2 (1.2) 13 (1.4) 0.2 Associated injury 3 (2.8) 5 (4.4) 8 (7.9) 4 (2.5) 6 (4.0) 3 (2.0) 4 (2.4) 0 (0) 0.2 Preoperative nerve palsy 24 (22.2) 21 (19.4) 17 (17.4) 22 (14.5) 19 (12.8) 18 (12.4) 34 (21.0) 23 (2.4) 0.3 Compartment syndrome 1 (0.9) 0 (0) 1 (1.02) 0 (0) 0 (0) 0 (0) 2 (1.2) 14 (1.5) 0.8 Vascular compromise 0 (0) 0 (0) 2 (2.0) 0 (0) 0 (0) 0 (0) 0 (0) 13 (1.4) 0.3 Reoperation (any reason) 3 (2.8) 0 (0) 4 (4.0) 2 (1.3) 4 (2.7) 1 (0.7) 4 (2.4) 10 (1.0) 1.0 Admission Transferred from outside hospital 89 (82.4) 88 (77.9) 72 (71.3) 120 (75.9) 116 (77.3) 118 (80.8) 127 (75.1) 0 (0) 0.6 Surgery in summer 74 (68.5) 89 (78.8) 75 (74.2) 113 (71.5) 112 (74.7) 102 (69.9) 120 (71.0) 0 (0) 0.6 Surgery after hours 52 (48.1) 59 (52.2) 50 (49.5) 100 (63.3) 86 (57.3) 74 (50.7) 98 (58.0) 0 (0) 0.2 Delay to fixation, mean ± SD, h 13.73 ±18.44 12.74 ± 5.99 11.53 ± 6.54 13.49 ± 7.54 12.39 ± 7.34 12.54 ± 6.71 11.27 ± 6.28 31 (3.3) 0.1 Surgical duration, mean ± SD, min 81.40 ± 21.51 81.60 ± 30.95 86.43 ± 59.75 85.13 ± 42.77 81.23 ± 32.35 78.42 ± 29.91 69.98 ± 32.87 4 (0.4) 0.003 Length of stay, mean ± SD, d 1.25 ± 1.08 1.22 ± 0.41 1.28 ± 0.70 1.20 ± 0.40 1.23 ± 0.43 1.22 ± 0.47 1.14 ± 0.48 4 (0.4) 0.2 Cost of index admission, mean ± SD, $ 2560 ± 1190 2306 ± 507 2685 ± 951 2512 ± 673 2529 ± 599 2457 ± 586 2353 ± 767 4 (0.4) 0.2 Note: SD = standard deviation.
*Except where noted otherwise.
Characteristic Year; no. (%) of patients* (n = 421) p value for trend 2008/09
(n = 47)2009/10
(n = 49)2010/11
(n = 52)2011/12
(n = 83)2012/13
(n = 55)2013/14
(n = 66)2014/15
(n = 69)Missing Demographic Age, mean ± SD, yr 5.19 ± 4.22 6.00 ± 4.55 5.65 ± 4.33 5.61 ± 4.44 6.80 ± 4.84 4.73 ± 4.28 4.97 ± 4.08 0 (0) 0.7 Female sex 14 (29.8) 7 (14.3) 18 (34.6) 20 (24.1) 16 (29.1) 18 (27.3) 15 (21.7) 0 (0) 0.8 Presence of any comorbidity 0 (0) 1 (2.0) 0 (0) 2 (2.4) 2 (3.6) 8 (12.1) 8 (11.6) 0 (0) < 0.001 Injury Fixation (v. spica casting) 15 (31.9) 24 (49.0) 23 (44.2) 38 (45.8) 30 (54.5) 24 (36.4) 29 (42.0) 0 (0) 0.8 High-energy mechanism 46 (97.9) 44 (89.8) 48 (92.3) 81 (97.6) 52 (94.5) 65 (98.5) 69 (100.0) 2 (0.5) 0.02 Open fracture 1 (2.1) 0 (0) 0 (0) 1 (1.2) 1 (1.8) 0 (0) 1 (1.4) 0 (0) 1.0 Associated injury 1 (2.1) 1 (2.0) 0 (0) 5 (6.0) 2 (3.6) 5 (7.6) 3 (4.3) 0 (0) 0.1 Reoperation (any reason) 3 (6.4) 11 (22.4) 7 (13.5) 16 (19.3) 11 (20.0) 8 (12.1) 2 (2.9) 0 (0) 0.2 Admission Transferred from outside hospital 38 (80.8) 40 (81.6) 46 (88.5) 59 (71.1) 47 (85.4) 48 (72.7) 60 (87.0) 0 (0) 1.0 Surgery in summer 18 (38.3) 28 (57.1) 29 (55.8) 50 (60.2) 30 (54.5) 35 (53.0) 38 (55.1) 0 (0) 0.3 Surgery after hours 31 (66.0) 28 (57.1) 31 (59.6) 43 (51.8) 32 (58.2) 33 (50.0) 27 (39.1) 0 (0) 0.005 Delay to fixation, mean ± SD, h 18.72 ± 26.01 24.13 ± 58.70 15.30 ± 8.55 19.77 ± 14.67 16.55 ± 12.04 15.65 ± 10.57 18.68 ± 22.20 7 (1.6) 0.1 Surgical duration, mean ± SD, min 99.13 ± 61.61 112.61 ± 57.52 104.31 ± 58.65 126.99 ± 83.65 129.11 ± 76.35 107.03 ± 72.10 97.14 ± 51.33 0 (0) 0.003 Length of stay, mean ± SD, d 2.57 ± 1.84 3.08 ± 3.11 2.29 ± 1.21 3.00 ± 3.32 2.29 ±1.24 2.35 ± 2.50 2.86 ± 6.39 0 (0) 0.2 Cost of index admission, mean ± SD, $ 4152 ± 2193 4865 ± 3961 4083 ± 1843 5541 ± 7728 4494 ± 2037 4871 ± 8029 6139 ± 17 646 0 (0) 0.2 Note: SD = standard deviation.
*Except where noted otherwise.
Fracture type; variable Adjusted IRR (95% CI) Supracondylar humerus Overall 1.075 (1.072-1.079) Transferred 1.069 (1.065-1.073) Direct presentation 1.075 (1.075-1.10) Gartland type II 1.088 (1.080-1.097) Gartland type III 1.070 (1.064-1.075) Femur Overall 1.053 (1.044-1.062) Transferred 1.056 (1.048-1.065) Direct presentation 1.060 (0.99-1.13) Spica casting 1.055 (1.037-1.74) Fixation 1.060 (1.043-1.69) Note: CI = confidence interval, IRR = incidence rate ratio.
*Supracondylar humerus operation rates were adjusted for age, sex, American Society of Anesthesiologists score, patient Local Health Integrated Network (LHIN), Gartland classification, open fracture, presence of preoperative nerve palsy, associated fracture, surgery in summer and after-hours surgery. Femur operation rates were adjusted for age, sex, presence of comorbidity, patient LHIN, injury severity (high/low energy), stabilization method, open fracture, associated fracture, surgery in summer and after-hours surgery.
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