Pediatric Elbow Fractures: New Criteria Released

Jennifer Garcia

September 16, 2014

The American Academy of Orthopaedic Surgeons (AAOS) recently released new guidelines to aid physicians in the management of pediatric patients with supracondylar humeral fractures. In addition, these criteria can now also be accessed via a new, Web-based mobile application for use on smartphones and tablets.

The Appropriate Use Criteria were published online September 5. They are intended to aid physicians in the treatment of these often-complex injuries as part of an effort to ensure appropriate therapy and improve patient outcomes. Algorithms included in the new criteria include 220 clinical scenarios and 14 treatment options intended to be inclusive of the heterogeneous patient population seen in daily practice. Treatment options are classified as "appropriate," "may be appropriate," or "rarely appropriate."

The AAOS writing panel recommends use of these criteria on the basis of a set of assumptions that are described early in the document. These assumptions are intended to "provide all readers with a common starting point in interpreting the clinical scenarios" and to take into consideration factors such as the patient being healthy enough to undergo surgery if it is needed, adequate radiographic images being obtained, and a surgeon being available that can appropriately perform the procedure in a timely manner. These assumptions will aid the physician in determining whether the injury is one that can be treated at their facility or one that would benefit from a transfer to another hospital.

In conjunction with the release of these new criteria, the AAOS has also developed "an intuitive and more user-friendly version" as a Web-based application practitioners can access from their smartphones and mobile devices. Within the mobile app, once the user reads through and accepts the initial assumptions, they are presented with treatment recommendations based on individual patient information such as the fracture type, vascular status, degree of swelling, status of the soft tissue envelope, or presence of nerve injuries. The recommendations are presented in order from most emergent to those that are "rarely appropriate."

"Evidence-based information, in conjunction with the clinical expertise of physicians from multiple medical specialties, was used to develop the criteria in order to improve patient care and obtain the best outcomes while considering the subtleties and distinctions necessary in making clinical decisions," the AAOS writing panel members note.

The AAOS received no outside funding for the development of these criteria. Individual disclosure information for the panel members is available within the document.

"Appropriate Use Criteria for the Management of Pediatric Supracondylar Humerus Fractures." American Academy of Orthopaedic Surgeons. Published online September 5, 2014. Full text

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