Do surgical technique and pin configuration influence clinical and radiological outcomes in pediatric supracondylar...

Pediatric supracondylar humerus fractures are among the most common elbow injuries in childhood. Although K-wire fixation is widely accepted, the optimal surgical technique and pin configuration remain controversial. Additionally, the Modified Flynn criteria, which assess both functional and cosmetic outcomes, have been less frequently utilized in the literature.

This study aimed to evaluate whether surgical technique and pin configuration influence clinical and radiological outcomes in pediatric supracondylar humerus fractures using Modified Flynn criteria.

This retrospective study included 78 pediatric patients who underwent surgical treatment for supracondylar humerus fractures between 2012 and 2021. Patients were categorized according to surgical technique (open vs. closed reduction) and pin configuration (lateral-only vs. medial-lateral fixation). Radiological parameters, including Baumann angle, carrying angle, and humerocapitellar angle, were assessed. Functional and cosmetic outcomes were evaluated using the Modified Flynn criteria. Range of motion was compared with the contralateral side. Statistical analyses were performed using SPSS, with p < 0.05 considered statistically significant.

Closed reduction was associated with a significantly shorter hospital stay compared to open reduction (p < 0.001). Gartland type II fractures demonstrated significantly shorter pin removal times than type III and IV fractures (p = 0.036). No significant differences were observed between surgical techniques or pin configurations in terms of radiological parameters or Modified Flynn functional and cosmetic outcomes (p > 0.05). According to the Modified Flynn cosmetic score, carrying angle and supination differed significantly between excellent and good outcome groups (p = 0.002 and p < 0.001, respectively). Based on the Modified Flynn functional score, flexion-extension arc and supination were significantly different between excellent-good and fair-poor outcome groups (p < 0.001 and p = 0.003, respectively). All observed nerve injuries resolved during follow-up, consistent with neuropraxia.

No significant differences were observed between lateral-only and crossed pin fixation regarding clinical, radiological, or Modified Flynn outcomes in this retrospective study. Both fixation methods provided satisfactory clinical and radiological outcomes when stable fracture reduction was achieved. These findings suggest that the choice of pin configuration should be individualized according to fracture characteristics and intraoperative stability rather than applied routinely. Larger prospective studies are warranted to confirm these findings.