Daytime Versus After-hours Surgical Fixation of Pediatric Supracondylar Humeral Fractures: A Meta-analysis.
Marc Boutros, Guy Awad, Jean-Pierre Saad et al.
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In 30 seconds
This systematic review and meta-analysis compared daytime with after-hours operative fixation of pediatric supracondylar humeral fractures. Seven comparative studies included 913 children. Operative time, medial pin fixation, open reduction, and several postoperative complications were not significantly different between groups. Surgery occurred sooner after-hours (P <0.001), while alignment-related complications were more frequent after-hours (P =0.04). Overall, the findings indicate broadly similar outcomes by timing, with a specific alignment-related signal that warrants consideration.
Key findings
- Seven studies included 913 pediatric patients undergoing operative fixation.
- Time to surgery was shorter after-hours (P <0.001), while operative time did not differ significantly (P =0.11).
- Medial pin fixation (P =0.70) and open reduction (P =0.80) rates did not differ significantly by timing.
- Alignment-related complications were more frequent after-hours (P =0.04); pin migration, infection, and iatrogenic postoperative nerve injury were comparable.
Why it matters
The findings suggest that after-hours fixation is not associated with broad differences in operative efficiency or several technical and postoperative outcomes, but the higher rate of alignment-related complications merits attention. This distinction can inform evaluation of timing-related outcomes without assuming that timing itself causes complications.
What to keep in mind
The meta-analysis included seven comparative studies; the abstract does not report study-level design details or pooled effect sizes, limiting assessment of the strength and precision of the comparisons.