Open reduction can be a reasonable, safe and effective choice in complex paediatric supracondylar humeral fractures...

Supracondylar humeral fractures are among the most common paediatric injuries. Displacement and consequent need for reduction impose operative treatment. Restoration of the anatomy of the distal part of the humerus prevents deformities and functional disorders of the elbow and upper limb. Stable K-wire fixation can be succeeded either by closed or open reduction method.

To investigate the safety and efficacy of open reduction method in the operative treatment of Gartland type III and IV supracondylar humeral fractures in children.

We retrospectively studied 131 cases of paediatric supracondylar humerus fractures of Gartland type III-IV treated operatively by open reduction and pinning between 2001 and 2023 in our department. All patients underwent clinical and radiological examination recording elbow range of motion, function and deformity.

The standard lateral approach was carried out in all patients while in 47 cases (35.9%) additional medial approach was used. Average follow-up time was 5.4 years (1-14 years). Fracture healing was completed at 4-6 weeks. The average operative time was 50 min (range: 37-75 minutes, SD: 11.307) and the average duration of radiation exposure based on image intensifier usage time was 20 seconds (range: 7-45 seconds, SD: 9.864). No infections or iatrogenic neurovascular complications were recorded and the functional outcome regarding range of motion, Patient-Reported Outcome Measures (Disabilities of the Arm, Shoulder, and Hand questionnaire, Mayo Elbow Performance Scores) at 2-year follow-up was satisfying.

Open reduction and K-wire fixation provide very satisfactory outcome in supracondylar fractures of the humerus in children with reduced radiation burden. Moreover, the risk of neurovascular injuries due to manipulations of closed reduction, is minimized while complications related to surgical approaches are insignificant provided there is expertise.