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Radiographic and clinical factors associated with open reduction in pediatric supracondylar humerus fractures
Emre Kocazeybek1, Mehmet Ersin1, Yasin Dogan1
1Department of Orthopaedics and Traumatology, Haseki Training and Research Hospital, University of Health Sciences, İstanbul-Türkiye.
Background:
The aim of this study was to evaluate demographic and radiographic factors associated with the likelihood of open reduction in pediatric supracondylar humerus fractures (SCHF).
Methods:
A total of 294 pediatric patients with SCHFs treated operatively between 2016 and 2025 were retrospectively reviewed. Patients were divided into two groups: Open reduction (OR, n=128) and closed reduction (CR, n=166). Demographic variables, including age, sex, side of injury, and surgeon experience, were recorded. Radiographic parameters assessed on preoperative anteroposterior and lateral elbow radiographs included fracture type, displacement direction, rotational deformity, diaphyseal involvement, coronal fracture pattern, sagittal fracture pattern, and coronal alignment. Variables with p<0.05 in univariate analysis were included in a multivariable logistic regression model using a backward stepwise method.
Results:
The mean age was significantly higher in the OR group compared to the CR group (6.94±2.85 vs. 5.58±2.64 years, p<0.001). Flexion-type fractures were more frequent in the OR group (24.2% vs. 10.2%, p=0.012). Posterolateral displacement and rotational deformity were also significantly associated with open reduction. Coronal alignment differed significantly between groups, with varus and valgus malalignment more common in the OR group (p=0.003). Multivariable logistic regression analysis identified increasing age (OR=1.127, 95% confidence interval [CI]: 1.029-1.236; p=0.010), flexion-type fractures (OR=1.807, 95% CI: 1.261-2.590; p=0.001), and posterolateral displacement (OR=1.39, 95% CI: 1.010-1.926; p=0.043) as independent predictors of open reduction. In contrast, neutral coronal alignment was associated with a lower likelihood of open reduction (OR=0.681, 95% CI: 0.510-0.909; p=0.009).
Conclusion:
Several demographic and fracture-related characteristics were independently associated with the likelihood of open reduction in pediatric SCHFs. Among these, fracture-related characteristics, particularly displacement pattern and coronal alignment, showed the strongest associations with open reduction. Recognition of these associated factors may assist preoperative planning and help surgeons anticipate technically challenging reductions.
