Bone Remodeling after Supracondylar Fractures in Children: myth or reality? A review of 97 Cases

Supracondylar humerus fractures are common injuries, representing more than half of pediatric elbow fractures. Given the limited growth potential around the elbow, achieving an anatomic reduction has traditionally been emphasized. However, the extent to which residual postoperative frontal or sagittal translation can be tolerated without cosmetic or functional consequences remains unclear.

We hypothesized that an initial reduction defect, particularly translational, would not result in functional impairment at skeletal maturity due to growth-related remodeling, whereas angular deformities would persist.

We included 97 children who underwent surgical fixation for a supracondylar humerus fracture between 2004 and 2017 and had reached skeletal maturity at final follow-up. Baumann's angle, percentages of frontal and sagittal translation, and the position of the anterior humeral line were assessed postoperatively, at the time of hardware removal, and at skeletal maturity.

Overall, 55% of patients demonstrated an initial reduction defect, regardless of the parameter considered. Frontal translation underwent complete remodeling with growth, whereas a mean residual sagittal translation of 7% persisted but had no clinical impact. In contrast, only 6% of patients with an abnormal postoperative Baumann's angle showed normalization over time. Clinical evaluation at maturity revealed no significant functional differences compared with the contralateral elbow.

This study underscores the excellent remodeling potential of translational deformities and confirms progressive correction of sagittal deviations. Although Baumann's angle demonstrates poor remodeling capacity, the absence of functional impairment precludes defining corrective thresholds that would mandate surgical revision.

IV; Retrospective observational study.