{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T13:03:49Z","timestamp":1781269429839,"version":"3.54.1"},"reference-count":21,"publisher":"MJS Publishing, Medical Journals Sweden AB","license":[{"start":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T00:00:00Z","timestamp":1781222400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["ActaO"],"abstract":"<jats:p>Background and purpose:\u00a0There 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:\u00a0This retrospective study reviewed all fractures diagnosed at HUS New Children\u2019s 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\u2013Dindo\u2013Sink system was used in complex fractures. Permanent iatrogenic nerve injuries and deep infections were registered in all fractures.Results:\u00a010,144 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:\u00a0Surgical 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.<\/jats:p>","DOI":"10.2340\/17453674.2026.46044","type":"journal-article","created":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T12:51:42Z","timestamp":1781268702000},"source":"Crossref","is-referenced-by-count":0,"title":["Treatment and outcomes of fractures in children: a registry-based cohort study of 10,144 fractures"],"prefix":"10.2340","volume":"97","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3925-2446","authenticated-orcid":false,"given":"Topi","family":"Laaksonen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3018-8270","authenticated-orcid":false,"given":"Petra","family":"Grahn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0330-5032","authenticated-orcid":false,"given":"Matti","family":"Ahonen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juho-Antti","family":"Ahola","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5200-3279","authenticated-orcid":false,"given":"Ilkka","family":"Helenius","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2220-8008","authenticated-orcid":false,"given":"Yrj\u00e4n\u00e4","family":"Nietosvaara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1183","published-online":{"date-parts":[[2026,6,12]]},"reference":[{"key":"158851","unstructured":"Olmsted M G, R, Powell R, Murphy J, Bell D, Stanley M, et al. Methodology: U.S. News & World Report Best Children\u2019s Hospitals 2022\u201323. 2023 July; 21: p. 120. Available from: https:\/\/health.usnews.com\/media\/best-hospitals\/BCH_Methodology_2022-23.pdf"},{"key":"158852","doi-asserted-by":"crossref","unstructured":"Dindo D, Demartines N, Clavien P A. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004; 240(2): 205-13. doi: 10.1097\/01.sla.0000133083.54934.ae.","DOI":"10.1097\/01.sla.0000133083.54934.ae"},{"key":"158853","doi-asserted-by":"crossref","unstructured":"Dodwell E R, Pathy R, Widmann R F, Green D W, Scher D M, Blanco J S, et al. Reliability of the modified Clavien\u2013Dindo\u2013Sink complication classification system in pediatric orthopaedic surgery. JB JS Open Access. 2018; 3(4): e0020. doi: 10.2106\/JBJS.OA.18.00020.","DOI":"10.2106\/JBJS.OA.18.00020"},{"key":"158854","doi-asserted-by":"crossref","unstructured":"Shrank W H, Rogstad T L, Parekh N Waste in the US health care system: estimated costs and potential for savings. JAMA 2019; 322(15): 1501-9. doi: 10.1001\/jama.2019.13978.","DOI":"10.1001\/jama.2019.13978"},{"key":"158855","doi-asserted-by":"crossref","unstructured":"Braithwaite J, Glasziou P, Westbrook J The three numbers you need to know about healthcare: the 60-30-10 Challenge. BMC Med 2020; 18(1): 102. doi: 10.1186\/s12916-020-01563-4.","DOI":"10.1186\/s12916-020-01563-4"},{"key":"158856","doi-asserted-by":"crossref","unstructured":"Gelfer Y, Ashby E, Perry D C Paediatric orthopaedics. Bone Joint J 2025; 107-B(1): 3-4. doi: 10.1302\/0301-620X.107B1.BJJ-2024-1151.-4.","DOI":"10.1302\/0301-620X.107B1.BJJ-2024-1151"},{"key":"158857","doi-asserted-by":"crossref","unstructured":"Grauberger J, O\u2019Byrne M, Stans A A, Shaughnessy W J, Larson A N, Milbrandt T A Does shorter time to treatment of pediatric femur shaft fractures impact clinical outcomes? J Pediatr Orthop 2020; 40(6): e435-e439. doi: 10.1097\/BPO.0000000000001544.","DOI":"10.1097\/BPO.0000000000001544"},{"key":"158858","doi-asserted-by":"crossref","unstructured":"Ondina A B, Haidar L A, Goldberg B, Mansour A 3rd, Younas S, Siahaan J, et al. Factors associated with conversion to open reduction of type 3 supracondylar humerus fractures in children. J Clin Orthop Trauma 2022; 30: 101893. doi: 10.1016\/j.jcot.2022.101893.","DOI":"10.1016\/j.jcot.2022.101893"},{"key":"158859","doi-asserted-by":"crossref","unstructured":"Transtrum M B, Sanchez D, Griffith S, Godinez B, Singh V, Klahs K J, et al. Predictors associated with the need for open reduction of pediatric supracondylar humerus fractures: a meta-analysis of the recent literature. JB JS Open Access 2024; 9(3): e24.00011. doi: 10.2106\/JBJS.OA.24.00011.","DOI":"10.2106\/JBJS.OA.24.00011"},{"key":"158860","doi-asserted-by":"crossref","unstructured":"Tuomilehto N, Sommarhem A, Salminen P, Nietosvaara A Y Postponing surgery of paediatric supracondylar humerus fractures to office hours increases consultant attendance in operations and saves operative room time. J Child Orthop 2018; 12(3): 288-93. doi: 10.1302\/1863-2548.12.170144.","DOI":"10.1302\/1863-2548.12.170144"},{"key":"158861","doi-asserted-by":"crossref","unstructured":"Fisher B T, Chong A C M, Flick T, Forness M, Sauer B R, Peterson J B Does surgeon subspecialty training affect outcomes in the treatment of displaced supracondylar humerus fractures in children? J Am Acad Orthop Surg 2021; 29(9): e447-e457. doi: 10.5435\/JAAOS-D-20-00507.","DOI":"10.5435\/JAAOS-D-20-00507"},{"key":"158862","doi-asserted-by":"crossref","unstructured":"Terpstra S E S, Burgers P T P W, van der Heide H J L, Witte P B Pediatric supracondylar humerus fractures: should we avoid surgery during after-hours? Children (Basel) 2022; 9(2): 189. doi: 10.3390\/children9020189.","DOI":"10.3390\/children9020189"},{"key":"158863","doi-asserted-by":"crossref","unstructured":"Sullivan M H, Stillwagon M R, Nash A B, Jiang H, Lin F-C, Chen A T, et al. Complications with surgical treatment of pediatric supracondylar humerus fractures: does surgeon training matter? J Pediatr Orthop 2022; 42(1): e8-e14. doi: 10.1097\/BPO.0000000000001969.","DOI":"10.1097\/BPO.0000000000001969"},{"key":"158864","doi-asserted-by":"crossref","unstructured":"Abbott M D, Buchler L, Loder R T, Caltoum C B Gartland type III supracondylar humerus fractures: outcome and complications as related to operative timing and pin configuration. J Child Orthop 2014; 8(6): 473-7. doi: 10.1007\/s11832-014-0624-x.","DOI":"10.1007\/s11832-014-0624-x"},{"key":"158865","doi-asserted-by":"crossref","unstructured":"Kwiatkowska M, Dhinsa B S, Mahapatra A N Does the surgery time affect the final outcome of type III supracondylar humeral fractures? J Clin Orthop Trauma 2018; 9(Suppl 1): S112-S5. doi: 10.1016\/j.jcot.2017.08.016.","DOI":"10.1016\/j.jcot.2017.08.016"},{"key":"158866","doi-asserted-by":"crossref","unstructured":"M\u00e4yr\u00e4np\u00e4\u00e4 M K, M\u00e4kitie O, Kallio P E Decreasing incidence and changing pattern of childhood fractures: a population-based study. J Bone Miner Res 2010; 25(12): 2752-9. doi: 10.1002\/jbmr.155. Erratum In: J Bone Miner Res 2011; 26(2): 439.","DOI":"10.1002\/jbmr.155"},{"key":"158867","doi-asserted-by":"crossref","unstructured":"Sinikumpu J J, Lautamo A, Pokka T, Serlo W The increasing incidence of paediatric diaphyseal both-bone forearm fractures and their internal fixation during the last decade. Injury 2012; 43(3): 362-6. doi: 10.1016\/j.injury.2011.11.006.","DOI":"10.1016\/j.injury.2011.11.006"},{"key":"158868","doi-asserted-by":"crossref","unstructured":"Ashby K, Pointer S, Eager D, Day L Australian trampoline injury patterns and trends. Aust N Z J Public Health 2015; 39(5): 491-4. doi: 10.1111\/1753-6405.12404.","DOI":"10.1111\/1753-6405.12404"},{"key":"158869","doi-asserted-by":"crossref","unstructured":"Schuller A, Hohensteiner A, Sator T, Pichler L, Jaindl M, Schwendenwein E, et al. Paediatric e-scooter riders at high risk of life-threatening traffic accidents. 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