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In the Treatment of Supracondylar Humerus Fractures, Open or Closed Reduction With Percutaneous Pinning Results in
Wen-Hao Chang1, Kuan-Ying Wu1, Yi-Wen Chen1
1Department of Orthopaedic Surgery, MacKay Memorial Hospital, Taipei.
Insights
Open reduction and percutaneous pinning (ORPP) and closed reduction and percutaneous pinning (CRPP) for pediatric supracondylar humeral fractures show similar postoperative pain and opioid use. The ORPP technique does not increase pain despite an additional incision.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Pain management
Background:
- Pediatric supracondylar humeral fractures are common and often require surgical fixation.
- Closed reduction and percutaneous pinning (CRPP) and open reduction and percutaneous pinning (ORPP) are surgical techniques used.
- Concerns exist regarding postoperative opioid use in pediatric patients.
Purpose of the Study:
- To compare postoperative pain and analgesic requirements between CRPP and ORPP in pediatric supracondylar humeral fractures.
- To evaluate the impact of surgical technique on opioid consumption.
- To inform clinical decision-making regarding pain management strategies.
Main Methods:
- Retrospective cohort study of 207 pediatric patients (ages 1-13).
- Comparison of CRPP (n=167) versus ORPP (n=40) surgical fixation.
- Postoperative pain assessed using FLACC and NPRS scales.
- Opioid administration and morphine milligram equivalents (MME) recorded.
Main Results:
- Comparable postoperative pain scores between ORPP and CRPP groups on postoperative days 0 and 1.
- No significant difference in overall opioid use (16.4% of patients) or MME between the two techniques.
- Similar rates of rescue analgesic administration and types of analgesics used across groups.
Conclusions:
- ORPP and CRPP yield similar postoperative pain levels and opioid requirements in pediatric supracondylar humeral fractures.
- The additional incision in ORPP does not lead to increased postoperative pain.
- This suggests that ORPP is a viable alternative to CRPP with comparable pain profiles.
Background:
Pediatric supracondylar humeral fractures often require surgical fixation through closed reduction and percutaneous pinning (CRPP) or open reduction and percutaneous pinning (ORPP). Concerns about postoperative opioid use in children necessitate evaluation of pain and analgesic requirements between the 2 techniques.
Methods:
This single-center, retrospective cohort study included 207 patients aged 1 to 13 years or younger who underwent CRPP (n=167) or ORPP (n=40) between 2013 and 2025. Postoperative pain was assessed using the Face, Legs, Activity, Cry, and Consolability (FLACC) scale and the Numerical Pain Rating Scale (NPRS) at 9 PM on postoperative day 0 and 9 am on postoperative day 1. Analgesic administration, including opioid use and morphine milligram equivalents (MME), as well as rescue analgesics, was recorded. Demographic data, fracture type according to the Gartland classification, and intraoperative variables were collected. Comparisons between groups were performed using Mann-Whitney U and χ 2 tests, with significance defined as P <0.05.
Results:
Postoperative pain scores were comparable between ORPP and CRPP groups on both day 0 (FLACC scale 2.5±0.8 vs. 2.7±1.2, P =0.613; NPRS 2.7±1.1 vs. 2.7±1.0, P =0.754) and day 1 (FLACC scale 1.6±2.1 vs. 1.8±1.1, P =0.108; NPRS 1.9±1.0 vs. 1.8±0.9, P =0.901). Overall, 16.4% of patients received opioids, with no significant difference in MME or opioid use between groups. The proportion of patients requiring rescue analgesics and the type of analgesics used were also similar.
Conclusion:
ORPP and CRPP resulted in comparable postoperative pain and opioid requirements, indicating that the additional incision in ORPP does not increase postoperative pain in pediatric supracondylar humeral fractures.
Level Of Evidence:
Level III.
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