Open Reduction of Paediatric Supracondylar Humerus Fractures has No Negative Impact on Long-term Functional Outcome and Quality of Life Compared to Closed Reduction

Abstract

Aim of the Study

The aim of the study was to compare closed and open reduction of displaced paediatric supracondylar humerus fractures with regard to long-term functional outcome and quality of life.

Material and Methods

In this retrospective study, 30 patients were examined with a displaced supracondylar humerus fracture (14 boys and 16 girls with a median age of 7 years [5–12 years]). The right elbow was affected in 8 cases (27%) and the left elbow in 22 cases (73%). According to the Gartland/Wilkins classification, there were 3× type IIA (10%), 8 × type IIB (27%), 18 × type III (60%) fractures (missing data n = 1 [3%]). All fractures were fixed with a crossed K-wire osteosynthesis. In the 1st group (n = 12), the fractures were reduced closed. In the 2nd group (n = 18), an open reduction was performed. The Quick Disabilities of the Arm, Shoulder and Hand Score (Quick-DASH) and the Paediatric Quality of Life Score (PedsQL) were recorded as outcome parameters after a mean follow-up of 53 months. The two groups were compared in terms of patient- and treatment-related factors and outcome parameters.

Results

The proportion of right elbow fractures was significantly higher in group 1 than in group 2 (50% vs. 11%). In group 2, the proportion of more severely displaced fractures was significantly higher than in group 1 (Gartland/Wilkins type III: 98% vs. 17%) and the median operating time was significantly longer (93 min vs. 26 min). There were no significant differences between the two groups in the Quick-DASH (0 [0–39] vs. 0 [0–11], p = 0.219), in the additional module “Sports and Music” of the Quick-DASH (0 [0–37.5], missing data n = 2, vs. 0 [0–50], p = 0.284) and in the PedsQL (95 [63–100] vs. 96 [86–100], p = 0.328).

Conclusion

Open reduction of displaced paediatric supracondylar humerus fractures does not lead to a reduction in long-term functional outcome and quality of life compared to closed reduction.

Keywords

supracondylar - humerus - fracture - outcome - reduction

• References/Literatur

• 1 Alton TB, Werner SE, Gee AO. Classifications in brief: the Gartland classification of supracondylar humerus fractures. Clin Orthop Relat Res 2015; 473: 738-741
• 2 Omid R, Choi PD, Skaggs DL. Supracondylar humeral fractures in children. J Bone Joint Surg Am 2008; 90: 1121-1132
• 3 Abzug JM, Herman MJ. Management of supracondylar humerus fractures in children: current concepts. J Am Acad Orthop Surg 2012; 20: 69-77
• 4 Ladenhauf HN, Schaffert M, Bauer J. The displaced supracondylar humerus fracture: indications for surgery and surgical options: a 2014 update. Curr Opin Pediatr 2014; 26: 64-69
• 5 Beck JD, Riehl JT, Moore BE. et al. Risk factors for failed closed reduction of pediatric supracondylar humerus fractures. Orthopedics 2012; 35: e1492-1496
• 6 Sun LJ, Wu ZP, Yang J. et al. Factors associated with a failed closed reduction for supracondylar fractures in children. Orthop Traumatol Surg Res 2014; 100: 621-624
• 7 Suganuma S, Tada K, Takagawa S. et al. Independent predictors affecting the reduction of pediatric supracondylar humerus fractures: a retrospective cohort study. Eur J Orthop Surg Traumatol 2021; 31: 399-406
• 8 Kolac UC, Oral M, Sili MV. et al. Identifying Risk Factors for Open Reduction in Pediatric Supracondylar Humerus Fractures. J Pediatr Orthop 2024; 44: 573-578
• 9 Wang Y, Chong Q, Zhang S. et al. Analysis of risk factors for failed closed reduction in pediatric Gartland Type III supracondylar humerus fracture. J Shoulder Elb Surg 2024; 33: 2279-2289
• 10 Hussein Al-Algawy AA, Aliakbar AH, Witwit IHN. Open versus closed reduction and K-wire fixation for displaced supracondylar fracture of the humerus in children. Eur J Orthop Surg Traumatol 2019; 29: 397-403
• 11 Tarallo L, Novi M, Porcellini G. et al. Gartland type III supracondylar fracture in children: is open reduction really a dangerous choice?. Injury 2022; 53 (Suppl. 1) S13-S18
• 12 Herman MJ, Boardman MJ, Hoover JR. et al. Relationship of the anterior humeral line to the capitellar ossific nucleus: variability with age. J Bone Joint Surg Am 2009; 91: 2188-2193
• 13 Williamson DM, Coates CJ, Miller RK. et al. Normal characteristics of the Baumann (humerocapitellar) angle: an aid in assessment of supracondylar fractures. J Pediatr Orthop 1992; 12: 636-639
• 14 Liebs TR, Burgard M, Kaiser N. et al. Health-related quality of life after paediatric supracondylar humeral fractures. Bone Joint J 2020; 102-B: 755-765
• 15 Germann G, Harth A, Wind G. et al. [Standardisation and validation of the German version 2.0 of the Disability of Arm, Shoulder, Hand (DASH) questionnaire]. Unfallchirurg 2003; 106: 13-19
• 16 Mahan ST, Kalish LA, Connell PL. et al. PedsQL correlates to PODCI in pediatric orthopaedic outpatient clinic. J Pediatr Orthop 2014; 34: e22-26
• 17 Flynn JC, Matthews JG, Benoit RL. Blind pinning of displaced supracondylar fractures of the humerus in children. Sixteen years’ experience with long-term follow-up. J Bone Joint Surg Am 1974; 56: 263-272
• 18 Seo KB, Kim BS, Park YG. et al. Associated Factor and Long-Term Clinical Outcomes for Patients with Postoperative Rotational Malreduction in Pediatric Supracondylar Humeral Fractures. Medicina (Kaunas) 2024; 60: 791
• 19 Cramer KE, Devito DP, Green NE. Comparison of closed reduction and percutaneous pinning versus open reduction and percutaneous pinning in displaced supracondylar fractures of the humerus in children. J Orthop Trauma 1992; 6: 407-412
• 20 Wingfield JJ, Ho CA, Abzug JM. et al. Open Reduction Techniques for Supracondylar Humerus Fractures in Children. J Am Acad Orthop Surg 2015; 23: e72-80
• 21 Kzlay YO, Aktekin CN, Özsoy MH. et al. Gartland Type 3 Supracondylar Humeral Fractures in Children: Which Open Reduction Approach Should Be Used After Failed Closed Reduction?. J Orthop Trauma 2017; 31: e18
• 22 Etier BEJ, Doyle JS, Gilbert SR. Avascular Necrosis of Trochlea After Supracondylar Humerus Fractures in Children. Am J Orthop (Belle Mead NJ) 2015; 44: E390-393
• 23 Schulte DW, Ramseier LE. Fishtail deformity as a result of a non-displaced supracondylar fracture of the humerus. Acta Orthop Belg 2009; 75: 408-410
• 24 Yang Z, Wang Y, Gilula LA. et al. Microcirculation of the distal humeral epiphyseal cartilage: implications for post-traumatic growth deformities. J Hand Surg Am 1998; 23: 165-172
• 25 Bronfen CE, Geffard B, Mallet JF. Dissolution of the trochlea after supracondylar fracture of the humerus in childhood: an analysis of six cases. J Pediatr Orthop 2007; 27: 547-550