Analysis of Reinterventions in Children’s Fractures—an Aspect of Quality Control

Background:

For a long time, orthopedic treatment was the first choice in pediatric fracture care. This often required more than one intervention. Meanwhile, new surgical modalities and differentiated techniques allow primary definitive (operative) fracture care in unstable fractures. The number of reinterventions show how often the initial decision failed.

Patients and Methods:

During a 3-year period, 1,497 children with limb fractures were treated. 65% received a plaster, 10.9% needed reduction before getting a cast, and 24.1% were stabilized with any kind of osteosynthesis.

Results:

In 62 cases (4.1%), a second intervention became necessary. The main causes were misjudged stability of orthopedically treated forearm fractures (secondary osteosynthesis), insufficient Kirschner wire (K-wire) fixation of supracondylar fractures (reosteosynthesis), or other technical faults in osteosynthesis requiring revision. The number of reinterventions decreased over the 3-year study period.

Conclusion:

Initial definitive fracture care was seen in 95.9% of cases, but the 4.1% that failed requires further attention. Watchful and critical assessment of the stability of each orthopedic or surgical procedure is indispensable to further reduce the number of children who receive delayed treatment or repeated anesthesia.

Authors and Affiliations

1. Department of Pediatric Surgery, St. Hedwigs Hospital, Clinical Center Barmherzige Brüder, Regensburg, Germany

   Peter P. Schmittenbecher MD

2. Department of Pediatric Surgery, St. Hedwigs Hospital, Steinmetzstraße 1–3, 93049, Regensburg, Germany

   Peter P. Schmittenbecher MD

Corresponding author

Correspondence to Peter P. Schmittenbecher MD.

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