Documentation of Assessment in Supracondylar Fractures of the Humerus in Children – Compliance with BOAST 11 Guidelines

Miss Laura Bowen, Miss Neala Glynn,

Background: Supracondylar humeral fractures are a common injury seen in children. There is a risk of significant complications including nerve injury, vascular compromise, compartment syndrome and clinical deformity. They can be difficult to manage. BOAST (British Orthopaedic Association Standards for Trauma) published guideline 11 in 2014 which lists criteria which should be assessed and documented for each child with this injury.

Method: A retrospective review of the available trauma admissions lists between 1^st January 2017 and 31^st October 2017 was undertaken to identify all patients admitted with a supracondylar fracture. Plain radiographs were reviewed and classified according to the Gartland system. Gartland Type 1 fractures were excluded. 16 cases were included. The electronic admission clerking was audited against BOAST 11 recommended standards for documentation of peripheral pulses, capillary refill time, and median, ulnar, radial and anterior interosseous nerve function.

Results: There were 7 cases of Gartland 2 and 9 cases of Gartland 3. Patients were assessed by either SHO or registrar level doctor, in 1 case there was a dual assessment. The radial pulse was referenced in 56% of cases and capillary refill time in 37% of cases. Documentation of individual nerve function was present in 69% of cases for the radial nerve and ulnar nerve, 75% for the median nerve, and 50% made reference to the anterior interosseous nerve. In the case of assessment by both SHO and registrar 100% of the documentation criteria were met. 100% of patients underwent surgery within 24 hours.

Conclusions: Documentation of the neurovascular status children presenting with supracondylar fractures is variable across all grades of assessing doctor. The phrase ‘neurovascular intact’ was frequently used, but is of inadequate standard for documenting the exact neurovascular status at the time of presentation according to BOAST guidelines.