Treatment results for pediatric orthopedics

In 2023, we treated 2,189 fracture patients under the age of 16 at New Children’s Hospital. All fracture patients who have received treatment at least once at New Children’s Hospital are included in the number. 
 

Table: Patient numbers 2018–2023 (Kids Fracture Tool)

In 2023, we performed a total of 516 fracture surgeries under general anesthesia at New Children’s Hospital.

Table: Number of surgeries 2018–2023 (Kids Fracture Tool)
 

We have collected the assessments of patients / their guardians on surgical fracture treatment and treatment satisfaction since 2021. The majority of patients attend all the fracture treatment units at New Children’s Hospital (emergency department, fracture outpatient clinic, surgery and anesthesia unit, inpatient ward).

In 2023, the average overall satisfaction (0–10) of patients treated with surgery / their guardians who responded to the survey was 8.93 (range 3–10). 

Table: Average treatment satisfaction in surgically treated fracture patients in 2021–2023 (Kids Fracture Tool)

Our goal is for at least 90% of patients with fractures of the distal humerus  (Gartland III supracondylar) to have surgery less than 18 hours after arriving at our hospital. In 2023, we achieved this goal (92%).
 

Table: Waiting times for surgical treatment of the lower humerus 2018–2023 (Kids Fracture Tool)

Our goal is for at least 80% of the patients with femoral shaft fractures to have surgery less than 18 hours after arriving at our hospital. In 2023, we achieved this goal (83%).

Table: Waiting times for surgical treatment of the femoral shaft 2018–2023 (Kids Fracture Tool)

A completely displaced fracture of the distal humerus (Gartland III supracondylar fracture) is associated with an increased risk of vascular and nerve injury in the injured limb. Treatment-related complications are also common, and an unwanted treatment outcome is the most common cause of a patient injury in pediatric fracture patients.

In 2023, of completely displaced fractures of the distal humerus (Grade III supracondylar), 16% were corrected in open surgery at New Children’s Hospital. Quality indicators for procedures can include, for example, the healing of the fractured bone to its normal position, the restoration of upper limb function, and the patient’s lack of symptoms.

In 2023, no vascular or nerve injuries related to these surgeries were observed at New Children’s Hospital, and no immediate repeat operations were performed, which we feel is a good result despite the relatively high proportion of fractures requiring open reduction.  An open reduction of a fracture always leaves a surgical scar in the area of the elbow joint.
 
 

Table: Number of surgeries for lower humerus fractures (Grade III supracondylar) 2018–2023 (Kids Fracture Tool)
 

In 2023, 1.7% (approx. 10) of fracture patients treated with surgery were diagnosed with surgical wound infection, one of whom was diagnosed with a deep infection. All patients, with the exception of one patient, recovered with antibiotic therapy without revision surgery.

In 2023, we treated 43 patients with open fractures, one of whom was diagnosed with a wound infection during treatment and none developed a deep infection. 

Table: Proportion (%) of infections in fracture surgeries in 2018–2023. (Kids Fracture Tool)

In fracture surgeries conducted in 2023, two patients (0.39% of all patients) suffered a temporary nerve injury which improved on follow-up without any new procedures required.
 
Within the last six years, one patient has experienced permanent nerve damage during fracture surgery (0.035% of all fracture surgeries).

Table: The proportion of nerve damage caused by fracture procedures. (Kids Fracture Tool)

The Patient Insurance Centre (PIC) processes patient injury reports concerning healthcare and medical care in Finland. Based on the opinions of independent experts, PIC determines whether the treatment received by the patient corresponds to the general good standard of care. The decision-making process is time-consuming, which is why the information shall be available with a delay of over a year.

In 2022, one compensated patient injury case was observed in connection with fracture treatment at New Children’s Hospital (0.05% of all fracture patients treated). 

In the past five years (2018–2022), the risk for fracture patients treated by us having a compensated patient injury is 0.06%.

Table: Percentage of fracture patient injuries covered by year

Specializing physicians are trained at New Children’s Hospital. In our fracture outpatient clinic, specializing physicians are introduced to the diagnostics and treatment of fractures in growing children. In addition, they are taught to use the Kids Fracture Tool in the diagnosis and treatment of fractures.

Table: In 2023, we trained 43 physicians specializing in the treatment of fractures in children at the pediatric fracture outpatient clinic. (Kids Fracture Tool)