Operative vs Non-operative Management of Type 2A Supracondylar Fractures of the Elbow: A Systematic Review

There is controversy in the literature surrounding the management of type 2a SCH fractures as to whether they should be operatively or non-operatively managed. Much of the current literature does not differentiate between type 2a and type 2b fractures. The aim of this study is to review the literature on the management of type 2a SCH as a separate entity.

A systematic search strategy was applied to PubMed central and Scopus to retrieve all studies published from inception until January 2024. Studies which specifically differentiated patients being managed for type 2a SCH fractures were included.

A total of 7 suitable studies were found, including a total of 409 patients. Three studies compared operatively, and non-operatively managed cohorts and the other three studies measured outcomes for a single treatment modality. Carrying angle was satisfactory in all cases with no significant difference between operative and non-operative groups. Range of motion was generally good, and no studies noted significant differences. Functional outcomes were good overall. Radiological outcomes at final follow-up were acceptable in all cases; however, 42 patients who were initially managed non-operatively were converted to operative management due to radiographic loss of reduction. Complication rates were low in both groups with one study demonstrating a similar rate of avascular necrosis and refracture in both groups. However, there was one operatively managed patient who developed a deep pin site infection.

Both operative and non-operative management have shown good outcomes in the management of type 2a SCH.