Mentored Professional Enrichment Experience
Applicant:
Andrew Mitchelson
Name of Project/Experience: Patient Demographics and Risk Factors in Pediatric Distal
Humeral Supracondylar Fractures
Location where Project/Experience will take place:
Southern Illinois University School of Medicine
Department of Surgery, Division of Orthopedics
747 N. Rutledge, Springfield IL 62794
Mentor Name and Contact Information:
Khaled J. Saleh, BSc, MD, MSc, FRCS(C), MHCM
SIU School of Medicine, Division of Orthopaedics, P.O. Box 19679, Springfield, IL
ksaleh@siumed.edu
217-545-8865
Brooke Robinson, MPH
SIU School of Medicine, Division of Orthopaedics, P.O. Box 19679, Springfield, IL
brobinson@siumed.edu
217-545-1387
RATIONALE
Elbow fractures are common in the pediatric population, accounting for 65% of
all pediatric fractures. Of those, 60% are manifest as supracondylar humeral fractures 1.
The modified Gartland system further classifies supracondylar humeral fractures into one
of 3 or 4 types. The classification type of each fracture is based upon degree of
displacement, extent of periosteal injury, neurovascular involvement, and degree of
stability 2. Treatment options include immobilization unaccompanied by other reductive
intervention, closed reduction with pin fixation, and open reduction with pin fixation 2.
Some literature already exists examining patient demographics and supracondylar
humeral fractures. One study has indicated an average age of supracondylar humeral
fracture occurrence around six years 3. Despite historic trends, there may be a female sex
predilection in these fractures 4. However, the findings of existing studies with regard to
sex demographics vary.
Demographic information that is not currently available with regard to
supracondylar humeral fractures includes patient ethnicity, body mass index (BMI)
trends, overall demographic trends (age, sex, ethnicity, BMI) specific to the modified
Gartland classification system, and overal demographic trends in relation to treatment
approaches.
Indentification of significant risk factors for the occurrence and severity of
pediatric supracondylar fractures will ultimately effect the treatment algorithm of these
patients. These fractures, despite being comparitively common, are associated with
significant complications. Knowledge of a significant risk factor-severity-complication
relationship will increase suspicion of complications in at-risk populations. Additionally,
such knowledge will aid in determining the most appropriate treatment approach to
address potential complications and to minimize their occurrence.
GOALS
Research goals for this MPEE project are:
1. To examine patient ethnicity in incidence of supracondylar humeral fractures
2. To examine body mass index in incidence of supracondylar humeral fractures
3. To examine trends in patient demographics and fracture classification (according
to the modified Gartland system of classification)
4. To examine trends in patient demographics and treatment approaches
5. To determine whether or not risk factors exist as predictors of supracondylar
humeral fracture severity.
Personal goals for this MPEE project are:
6. To gain exposure to the field of orthopedic surgery (through research, interactions
with attending and resident surgeons, and clinical experiences)
7. To begin to develop my capacity for clinical and translational research
8. To build a foundation for continued research and an evidence-based practice
METHODS
This project will begin with a review of all distal humeral supracondylar fractures
treated by SIU orthopedic surgeons over the last five years. We will request a report
from SIU SOM Information Resources that will show all of the patients who have ICD-9
codes 81241 and 81251 beginning January 2007 through January 2012. Based on
preliminary clinic data, we estimate that our sample size will be approximately 500
patients. This sample size is consistent with previously published epidemiological
studies on pediatric supracondylar humeral fractures 3,4. From the patient list, we will
retrospectively review each of the patients’ charts to collect age, sex, ethnicity, body
mass index, fracture classification, and treatment. We will enter this data into an excel
spreadsheet.
ANALYSIS
Once we have collected the data from Centricity and entered it into an excel
spreadsheet, the data will be imported into a statistical program, either SPSS or SAS. We
will work with a statistician using the statistical program to compute descriptive statistics
and uni- and multivariate analyses. Analysis will examine the trends between specific
demographics, injury types, and treatment approaches. Univariate and mulitvariate
analysis will be conducted, focusing on the association between patient demographics
and severity of disease (fracture pattern on plane radiographs and surgical procedure).
Statistical analysis will determine whether there is a statistically significant correlation
between patient demographics/risk factors and fracture severity. We hypothesize that
there will be a significant difference in prevalence of supracondylar fractures based on
gender, ethnicity, and BMI values. We also hypothesize that certain demographics will
predispose patients to the severity of their injury.
Completion of my personal goals will be determined by my level of involvement
within the Division of Orthopedics, my participation in research and clinical activities,
and my hopeful appeciation for the role of research in clinical practice.
SUPPORT
1. Do you request support funds? Yes No
2. Would you be able to participate if a scholarship is not available? Yes No
REFERENCES
1
Kasser JR, Beaty JH. Supracondylar fractures of the distal humerus. In: Beaty JH,
Kasser JR, Wilkins KE, Rockwood CE, editors. Rockwood and Wilkins’ fractures in
children. 6th ed. Philadelphia: Lippincott Williams and Wilkins; 2006. p 543-89.
2
Omid R, Choi PD, Skaggs DL. Supracondylar humeral fractures in children. J Bone
Joint Surg Am. 2008 May;90(5):1121-32.
3
Cheng JC, Lam TP, Maffulli N. Epidemiological features of supracondylar frac- tures
of the humerus in Chinese children. J Pediatr Orthop B. 2001;10:63-7.
4
Farnsworth CL, Silva PD, Mubarak SJ. Etiology of supracondylar humerus frac- tures.
J Pediatr Orthop. 1998;18:38-42.