Coronal obliquity in supracondylar humeral fracture of children may result in suboptimal reduction and delay in recovery of elbow range of motion-a retrospective comparative study.

Abstract

Pediatric supracondylar humeral fractures (SCHFs) with coronal obliquity pose unique intraoperative challenges and are believed to carry a higher risk of postoperative loss of reduction and delayed functional recovery. However, high-quality evidence supporting this association remains limited. This retrospective comparative study analyzed pediatric patients under 16 years of age who underwent closed reduction and percutaneous pinning for Gartland type III or IV SCHFs between 2016 and 2022. Based on preoperative radiographs, patients were classified into transverse or coronal oblique groups, with coronal obliquity defined as >10° on the anterior-posterior view. Postoperative radiographic parameters, complications, and recovery of elbow range of motion (ROM) were compared between groups. Among 88 patients, 52 had transverse and 36 had coronal oblique fractures. The coronal oblique group showed significantly higher rates of reduction outliers (anterior humeral line non-intersection: 36.1 % vs. 13.5 %, p = 0.013; malrotation: 22.2 % vs. 3.8 %, p = 0.008), loss of reduction (LOR) requiring reoperation (13.9 % vs. 0 %, p = 0.006), and delayed ROM recovery (19.4 % vs. 1.9 %, p = 0.011). No significant differences were observed in cosmetic or functional outcomes at six months (p = 0.311). Coronal obliquity in pediatric SCHFs is significantly associated with a higher incidence of reduction outliers and postoperative LOR. Consequently, these fractures are more likely to require revision surgery and demonstrate slower functional recovery of elbow motion during the early postoperative period compared with transverse-type fractures.