Pediatric supracondylar humerus fracture surgery: Is it possible to predict the need for closed or open reduction?

Abstract

Closed reduction and percutaneous pinning are the standard surgical treatment for displaced pediatric supracondylar humerus fractures. However, in some cases, open reduction is necessary. Research on this subject has not reached a consensus, and patient and fracture characteristics that can predict the need for closed or open reduction prior to treatment have not been clearly defined. In this study, we conducted a comprehensive evaluation of these characteristics with the aim of identifying variables that can predict the need for closed or open reduction. The study population consisted of patients aged 2 to12 years with supracondylar humerus fractures who underwent surgery at our institution's pediatric orthopedic and traumatology clinic between January 2013, and January 2021. The participants' demographic data and preoperative physical examination findings, the radiographic characteristics of the fractures, and the timing of surgery were recorded. The identified potential predictors were evaluated by multivariate logistic regression analysis. Univariate analyses revealed that sex,the presence of rotation,the fracture type, the displacement direction, the fracture orientation, and the fracture subtype in the coronal plane were important factors in determining the need for closed or open reduction (P = 0.034,<0.001, 0.028,<0.001,0.001,0.007, respectively). These variables were included in a multivariate regression analysis. The multivariate model showed a 0.37-fold increase in the need for open reduction in cases of rotation (OR 0.376;CI: 0.196-0.724). A 6.36-fold increase (OR 6.359;CI: 2.540-15.920) was observed in cases where the fracture fragment was displaced posteriorly. When the fracture fragment was varus-oriented,there was a 3.85-fold increase in the likelihood of closed reduction (OR 3.848;CI: 1.506-9.831). We found that the presence of rotation increases the likelihood that open reduction will be required for supracondylar humerus fractures.Posterior displacement of the fracture fragment and varus fracture orientation increases the likelihood of closed reduction. Hence, to achieve better clinical outcomes, we recommend that surgeons assess these factors when planning surgery for pediatric patients with supracondylar humerus fractures.