Factors associated with open reduction of pediatric type III supracondylar humerus fractures

Supracondylar fractures of the humerus are the most common elbow fractures in children. Surgical fixation is necessary in cases with complete displacement (Gartland type III), with closed reduction and pin fixation being preferred. It is sometimes impossible. This study examined radiological and clinical factors that influence the selection of open reduction methods for these fractures.

A retrospective study was designed to investigate children aged 3-13 years with Gartland type III supracondylar humeral fractures (OTA/AO 13-M/3.1 III) treated with closed and open reduction techniques. We enrolled 140 patients in the closed reduction group (mean age 6.27) and 90 in the open reduction group (mean age 6.86). The main outcomes were achieving adequate closed reduction or switching to open reduction. We used univariate analysis and multivariate logistic regression to find independent risk factors and odds ratios for open reduction and internal fixation.

Older children were significantly more likely to have flexion-type fractures (P = 0.001). The final univariate analysis showed that older age (odds ratios (95% confidence interval): 1.1 (1, 1.3)), flexion-type fractures (odds ratios (95% confidence interval): 3.2 (1.4, 7.4)), low-level (below isthmus) fractures (odds ratios (95% confidence interval): 2.2 (1.3, 3.9)), and Pucker sign (odds ratios (95% confidence interval): 2 (1, 4)) were factors that significantly increased the chance of open reduction and internal fixation. The influence of older age and low-level fracture was also strongly demonstrated in multivariate analysis.

As age increases, the chance of a flexion-type fracture rises, and thus the chance of needing open reduction. Low-level fractures reduce the possibility of achieving a stable closed reduction by creating a smaller, more cartilaginous distal fragment.

Level III.