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Surgical Timing and Approach in Gartland Type III Supracondylar Humerus Fractures in Children: Does After-Hours
Erkan Servet1, Murat Düzgün1, Musa Alperen Bilgin2
1Department of Orthopaedics and Traumatology, Faculty of Medicine, Gaziantep University, Gaziantep 27310, Turkey.
Insights
Surgery timing for pediatric Gartland Type III supracondylar humerus fractures (SCHFs) does not impact outcomes. However, after-hours open reduction is linked to poorer functional results, suggesting it should be done during working hours.
Area of Science:
- Pediatric Orthopedics
- Trauma Surgery
- Surgical Outcomes Research
Background:
- Gartland Type III supracondylar humerus fractures (SCHFs) are complex pediatric elbow injuries.
- The optimal timing for surgical intervention (working hours vs. after hours) remains debated.
- The influence of surgical approach (open vs. closed reduction) on outcomes is also considered.
Purpose of the Study:
- To compare clinical and radiological outcomes of Gartland Type III SCHFs based on surgical timing.
- To investigate the impact of surgical approach on outcomes in conjunction with timing.
- To determine if after-hours surgery affects functional, cosmetic, and radiological results.
Main Methods:
- Retrospective cohort study of 91 pediatric patients with Gartland Type III SCHFs.
- Patients stratified into working-hours (n=48) and after-hours (n=43) surgical groups.
- Outcomes assessed using Flynn's criteria, radiological parameters, range of motion, and complication rates; secondary analysis included surgical approach.
Main Results:
- Shorter time to surgery observed in the working-hours group (median 16.0h vs. 20.0h, p=0.009).
- No significant differences in overall functional, cosmetic, radiological outcomes, or complication rates between working-hours and after-hours groups.
- Subgroup analysis showed inferior functional outcomes (Flynn's criteria) in the after-hours open reduction group (76.92% excellent results vs. 96.88-100% in others).
Conclusions:
- Surgical timing alone (working hours vs. after hours) does not significantly affect outcomes for Gartland Type III SCHFs.
- Combining after-hours surgery with open reduction is associated with poorer functional outcomes.
- Complex fracture open reductions should ideally be performed during working hours for optimal surgical conditions and senior team availability.
Abstract:
Background/Objectives: Gartland Type III supracondylar humerus fractures (SCHFs) represent the most surgically challenging pediatric elbow injuries, yet controversy persists regarding whether the timing of surgery, specifically after-hours versus working-hours operations, influences clinical and radiological outcomes. This study aimed to compare the functional, cosmetic, and radiological outcomes of Gartland Type III SCHFs managed during working hours versus after hours, with a secondary analysis incorporating the surgical approach (open vs. closed reduction). Methods: A retrospective cohort study was conducted, including 91 pediatric patients who underwent surgical treatment for Gartland Type III SCHFs between January 2020 and June 2025. Patients were stratified into working-hours (n = 48) and after-hours (n = 43) groups. Outcomes were assessed using Flynn's criteria, radiological parameters, range-of-motion measurements, and complication rates. A secondary subgroup analysis was performed across four groups formed by combining surgical timing and approach. Results: The mean patient age was 70.36 ± 32.97 months with a mean follow-up of 28.07 ± 14.66 months. The time to surgery was significantly shorter in the working-hours group (median 16.0 h; IQR 13.5-20.0) compared with the after-hours group (median 20.0 h; IQR 17.0-27.0) (p = 0.009). No significant differences were observed between the two groups with respect to functional outcomes, cosmetic outcomes, radiological parameters, or overall complication rates (all p > 0.05). However, four-group subgroup analysis revealed a significant difference in Flynn's functional outcomes (p = 0.019), with the after-hours open reduction subgroup demonstrating a lower rate of excellent results (76.92%) compared with the remaining subgroups (96.88-100%). Conclusions: Working-hours versus after-hours surgical timing alone does not significantly alter clinical or radiological outcomes in Gartland Type III SCHFs. However, the combination of after-hours surgery with open reduction appears to be associated with inferior functional outcomes and a trend toward higher complication rates, suggesting that open reduction for complex fractures should preferably be performed during working hours when optimal theatre conditions and experienced senior surgical teams are readily available.
