Learning Curve of Closed Reduction and Internal Fixation for Supracondylar Fractures of the Humerus in Children

Chuang Qian; Yiming Zheng; Junrong Meng; Yueqiang Mo; Jinhua Sun; Hao Li; Dahui Wang

doi:10.3389/fped.2022.945616

Learning Curve of Closed Reduction and Internal Fixation for Supracondylar Fractures of the Humerus in Children

Front Pediatr. 2022 Jul 7:10:945616. doi: 10.3389/fped.2022.945616. eCollection 2022.

Authors

Chuang Qian¹, Yiming Zheng¹, Junrong Meng², Yueqiang Mo¹, Jinhua Sun³, Hao Li², Dahui Wang¹

Affiliations

¹ Department of Orthopedics, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China.
² Department of Neurosurgery, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China.
³ Shanghai Mental Health Center, Shanghai, China.

Abstract

Background: This study aimed to identify the threshold for success in supracondylar humeral fracture surgery by describing the learning curve for beginners and exploring the relationship between the learning curve and the prognosis of supracondylar fractures of the humerus.

Methods: Surgical information was collected of the first 100 humeral fractures treated by four pediatric orthopedic surgeons. The relationship between operation time, wire placement success rate, and surgical experience was determined using the restricted cubic strip (RCS). The inflection point in the curve and other risk factors that may affect fracture prognosis were collected and subjected to multiple logistic regression to clarify the relationship between the learning curve and prognosis of supracondylar fractures of the humerus. After the training, the four fresh surgeons were interviewed in the form of questionnaires to get feedback from the trainees.

Results: A total of 400 supracondylar fractures of the humerus from four pediatric orthopedists were included in the study. On an RCS analysis, 65 surgical experiences were the inflection point of the learning curve. Before and after these 65 surgical experiences, there were significant differences in the patients' anatomical reduction (186 vs. 122, P < 0.001), conversion to incision (33 vs. 6, P = 0.008), and supervising physician guidance (28 vs. 2, P < 0.001). In the multiple logistic regression analysis, functional recovery after supracondylar fractures of the humerus was significantly associated with surgical experience, intraoperative conversion to incision, and post-operative infection. Four surgeons and a supervisor were interviewed. They believed that self-confidence establishment requires the experience accumulation of about 30 operations. The most critical surgical technique is the reduction of fractures.

Conclusions: Although the accumulated experience of 30 operations can establish the self-confidence of trainers, fresh surgeons must accumulate experience with 65 operations to master closed reduction and internal fixation for supracondylar fractures. Surgical experience significantly impacts the post-operative recovery of patients with fractures.

Level of evidence: Level III.

Keywords: closed reduction; functional recovery; learning curve; specialist training; supracondylar fractures of the humerus.