Treatment and outcomes of fractures in children: a registry-based cohort study of 10,144 fractures

BACKGROUND AND PURPOSE: There is no universal consensus on evaluating the quality of pediatric fracture care. While U.S. News ranks hospitals based on surgical timing and procedural benchmarks, additional metrics such as complication rates, reoperations, and patient-reported outcomes could provide a more comprehensive assessment. We aimed to evaluate pediatric fracture care outcomes at a Level I trauma center, emphasizing standardization and transparency in benchmarking. METHODS: This retrospective study reviewed all fractures diagnosed at HUS New Children's Hospital, Helsinki from 2018 to 2022. U.S. News criteria were applied to completely dorsally displaced supracondylar humerus (Gartland III) fractures, femoral shaft fractures, and displaced forearm fractures to evaluate timeliness, method of treatment, and anesthesia use. The modified Clavien-Dindo-Sink system was used in complex fractures. Permanent iatrogenic nerve injuries and deep infections were registered in all fractures. RESULTS: 10,144 fractures were diagnosed, of which 18% were treated in the operative room. Surgery started within 18 h in 173 (87%) of Gartland III and 108 (79%) of femoral shaft fractures. Open reduction rate was 24% in Gartland III fractures. Most (60%) displaced forearm fractures were managed without general anesthesia. The overall complication rate for Gartland III and femoral shaft fractures was 13%; unplanned return to surgery occurred in 2.2% respectively. Permanent iatrogenic nerve injuries and deep infections were rare (0.04% and 0.3%) in all fractures. CONCLUSION: Surgical treatment of supracondylar humerus and femoral shaft fractures in children was performed safely and effectively at our institution. The majority of pediatric forearm fractures were managed in the emergency department without anesthesia. The incidence of iatrogenic nerve injuries and postoperative infections was very low. Incorporating broader metrics such as complications, outcomes, and satisfaction would offer a more complete assessment of care quality.