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A Meta-Analysis on Comparison of Open vs Closed Reduction of Gartland Type 3 Supracondylar Humerus Fractures in
1Department of Orthopedics, All India Institute of Medical Sciences, Deoghar, Jharkhand, India.
Insights
Closed reduction offers better functional outcomes for Type 3 Gartland supracondylar humerus fractures compared to open reduction. Cosmetic outcomes and complication rates were similar between both surgical interventions.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Traumatology
Background:
- Type 3 Gartland supracondylar humerus fractures require careful management.
- Optimal surgical approach (open vs. closed reduction) remains debated.
- Understanding outcomes and complications is crucial for treatment decisions.
Approach:
- Systematic literature search of Embase, MEDLINE, and Cochrane Library.
- Data extraction on study details, demographics, procedures, and outcomes (Flynn criteria).
- Pooled data analysis and comparison of open versus closed reduction techniques.
Key Points:
- No significant difference in cosmetic outcomes between open and closed reduction.
- Closed reduction demonstrated statistically better functional outcomes (RR 0.92).
- Overall complication rates and nerve injury incidence were comparable for both methods.
Conclusions:
- Closed reduction with percutaneous fixation yields superior functional outcomes for Type 3 Gartland fractures.
- Open reduction with K-wire fixation does not offer advantages in functional or cosmetic results.
- A high threshold for converting closed to open reduction is recommended in pediatric cases.
Abstract:
PURPOSE OF THE STUDY Although there are numerous studies on outcomes and comparison of open and closed reduction but there is no clarity on relationship between outcomes and complications with type of surgical intervention done for Type 3 Gartland supracondylar humerus fracture. The aim of this study is to compare the outcomes and complications of closed vs open reduction in Type 3 Gartland supracondylar humerus fractures. MATERIAL AND METHODS Electronic literature searches of Embase, MEDLINE and the Cochrane Library was conducted in February 2022 using the terms "supracondylar", "humerus", "fracture", "Gartland type 3" and synonymous. The data extracted included the study details, demographic data, procedure performed, final functional and cosmetic outcome according to Flynn criteria and complications of included studies. RESULTS Pooled data analysis revealed no significant difference in mean satisfactory outcome rate according to Flynn cosmetic criteria in open group (97%, 95% CI 95.5%-98.5%), as compared to closed group (97.5%, 95% CI 96.3%-98.7%), although a statistically significant difference in mean satisfactory rate according to Flynn functional criteria in open group (93.4%, 95% CI 90.8%- 96.1%) as compared to closed group (98.5%, 95% CI 97.5%-99.4%) was noted. On separate comparison of the two-arm studies, closed reduction favoured better functional outcomes (RR 0.92, 95% CI 0.86-0.99). CONCLUSIONS Closed reduction and percutaneous fixation have better functional outcome than open reduction with K-wire fixation. But there was no significant difference in cosmetic outcomes, overall complication rate and nerve injury with either open or closed reduction. The threshold of converting a closed reduction to an open reduction in supracondylar humerus fractures of children should be high. Key words: supracondylar humerus, open reduction, percutaneous pinning, Flynn criteria.
