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Delayed Presentation of Pediatric Supracondylar Humerus Fractures: Surgical Approach and Outcomes
Mohammed Yaqub1, Kiran Rajappa1, M S Rudraprasad1
1Department of Pediatric Orthopaedics, Indira Gandhi Institute of Child Health, Jayanagar 1st Block, Bengaluru, 560029 India.
Insights
Delayed pediatric elbow fractures treated with open reduction and internal fixation show excellent outcomes. Early surgical intervention within 7-21 days ensures proper healing, restores elbow function, and prevents long-term complications.
Area of Science:
- Pediatric Orthopedics
- Traumatology
- Surgical Innovation
Background:
- Supracondylar humerus fractures are common in children, accounting for 60% of elbow fractures.
- Delayed presentation (7-21 days) of these fractures poses treatment challenges.
- Current treatment for delayed pediatric supracondylar humerus fractures is debated.
Purpose of the Study:
- To define delayed presentation of pediatric supracondylar humerus fractures.
- To identify causes and indications for surgical intervention in delayed cases.
- To evaluate the outcomes of open reduction and internal fixation for these fractures.
Main Methods:
- Prospective observational study (2019-2022) at a pediatric tertiary care hospital.
- Included 28 patients aged 4-14 years with fractures presenting 7-21 days post-injury.
- All underwent open reduction and internal fixation via medial approach, with follow-up for 1 year.
Main Results:
- All 28 fractures achieved sound union by 8 weeks.
- Mean age was 8 years; average delay to surgery was 15 days.
- Full range of motion recovered in 67.8% by 3 months, and 32.14% by 5 months. Two cases (7.1%) had pin tract infection, resolving with antibiotics.
Conclusions:
- Children presenting 7-21 days after supracondylar humerus fracture are considered delayed.
- Open reduction via medial approach is safer and more effective in the reparative phase.
- Early surgery within this window restores alignment, prevents deformity, and avoids stiffness.
Purpose:
Supracondylar fracture of humerus accounts for 60% of all fractures around the elbow and represents 3% of all fractures in children. It is not uncommon to see these fractures presenting late to the hospital and its treatment is debatable. This study aims at defining delayed presentation, its causes, indications, and outcomes of open reduction and internal fixation in these fractures.
Methods:
This is a prospective observational study conducted between 2019 and 2022 at a Pediatric tertiary care hospital. The study population includes all patients within 18 years of age with delayed presentation of supracondylar fracture humerus, presenting between 7 and 21 days after injury. All children underwent open reduction and internal fixation via medial approach. Postoperatively, children were followed up monthly for 3 months and then quarterly for up to one year. At each visit, each child was evaluated clinically for elbow range of motion, carrying angle and radiological assessments were carried out. The end result was assessed using the Flynn's criteria.
Result:
Out of 28 fractures, all of them achieved sound union by 8 weeks. The majority of them were boys accounting for 64.2% and 35.8% were girls with a mean age of eight years [range: 4-14 years]. The average duration between injury and surgical intervention was 15 days [range: 5-21 days]. The average hospital stay was three days [range: 1-5 days]. Pin tract infection developed in two patients [7.1%], which resolved with oral antibiotics and K-wire removal after union. None of the patients had myositis ossificans and cubitus varus. The carrying angle was found to be 6° in males [range: 3°-7°] and 10° degrees in females [range: 6°-14°]. Range of movements had recovered fully in 19 patients [67.8%] at the end of 3 months, and the remaining nine patients [32.14%] gained full range of motion at the end of 5 months.
Conclusion:
Children presenting 7-21 days after a supracondylar humerus fracture may be considered delayed cases, often due to initial native treatment or limited specialist access. During this reparative phase, closed reduction is difficult, making open reduction via the medial approach safer and more effective. Early surgery within this window restores alignment, prevents deformity and stiffness, and avoids complex corrective procedures later.
Supplementary Information:
The online version contains supplementary material available at 10.1007/s43465-026-01741-1.
