Related Experiment Video
Updated: Jul 14, 2026
Creating Rigidly Stabilized Fractures for Assessing Intramembranous Ossification, Distraction Osteogenesis, or Healing of Critical Sized Defects
Published on: April 11, 2012
Fracture morphology and multidirectional instability in failed closed reduction of pediatric supracondylar humerus
Muhammed Furkan Darilmaz1, Mustafa Bulut1
1Training and Research Hospital, Aksaray University, Aksaray, Türkiye.
Insights
Flexion-type fractures and Gartland type IV instability in pediatric supracondylar humerus fractures (SCHF) predict failed closed reduction. Surgeons can use this to anticipate difficulty and plan resources for high-risk cases.
Area of Science:
- Orthopedic surgery
- Pediatric trauma
- Skeletal biomechanics
Background:
- Pediatric supracondylar humerus fractures (SCHF) are common, with Gartland type III and IV indicating significant instability.
- Failed closed reduction necessitates open reduction, increasing surgical complexity and potential complications.
Purpose of the Study:
- To identify clinical and fracture-related factors predicting failed closed reduction in high-risk pediatric SCHF.
- To emphasize the role of fracture morphology and intraoperative instability in reduction success.
Main Methods:
- Retrospective cohort study of 318 pediatric patients (2-12 years) with Gartland type III or IV SCHF.
- Fractures classified by morphology (typical, medial oblique, lateral oblique, flexion-type).
- Univariable and multivariable logistic regression analyses to determine predictors of open reduction.
Main Results:
- Closed reduction failed in 126 of 318 patients, requiring open reduction.
- Flexion-type fractures showed the highest open reduction rate (80.0%).
- Gartland type IV instability (OR 5.21) and flexion-type morphology were strongly associated with failed closed reduction. Older age and delayed surgery also increased odds.
Conclusions:
- Flexion-type morphology and intraoperative Gartland type IV instability are key predictors of failed closed reduction in pediatric SCHF.
- These factors aid surgeons in anticipating reduction challenges and optimizing operative planning for high-risk fractures.
Purpose:
To evaluate clinical and fracture-related factors associated with failed closed reduction in high-risk pediatric supracondylar humerus fractures (SCHF), with emphasis on fracture morphology and intraoperative multidirectional instability.
Methods:
This retrospective cohort study included 318 consecutive children aged 2-12 years who underwent surgery for Gartland type III SCHF or intraoperatively confirmed Gartland type IV instability between 2015 and 2025. Fractures were classified as typical extension-type, medial oblique, lateral oblique, or flexion-type. Univariable and multivariable logistic regression analyses were performed.
Results:
Closed reduction was successful in 192 patients, whereas 126 required conversion to open reduction. Flexion-type fractures had the highest open reduction rate (80.0%; p < 0.001). In the full multivariable model, Gartland type IV instability was strongly associated with open reduction (odds ratio 5.21, 95% confidence interval 2.69 to 10.53; p < 0.001). Compared with flexion-type fractures, typical, medial oblique, and lateral oblique patterns had significantly lower adjusted odds. Older age and longer time from injury to surgery were also associated with open reduction.
Conclusions:
Flexion-type morphology and intraoperatively confirmed Gartland type IV instability were strongly associated with failed closed reduction. These findings may help surgeons anticipate reduction difficulty and plan operative resources in high-risk pediatric SCHF.
Significance Of Study:
Recognizing fracture morphology and intraoperative multidirectional instability may help surgeons anticipate failed closed reduction in high-risk pediatric SCHF.
Level Of Evidence:
III.
