Clinical and logistical determinants of operative timing, surgical approach, and admission in paediatric supracondylar humerus fractures.

Abstract

Among children undergoing operative treatment for supracondylar humerus fractures, it is unclear which clinical and presentation characteristics available at triage best predict operative timing, surgical approach, and inpatient disposition. We examined this question using a multivariable approach in a decade of operatively managed fractures at a non-trauma-designated tertiary paediatric referral centre. We performed a retrospective cohort study of children aged ≤ 14 years with operatively managed supracondylar humerus fractures at a non-trauma-designated tertiary paediatric referral centre (2010-2020). Candidate predictors included clinical severity (Gartland classification), demographic characteristics, injury mechanism, and logistical presentation factors. Multivariable Firth logistic regression models were constructed for each primary outcome. Of 242 patients, 160 (66.1%) had high-severity fractures (Gartland III+). These high-severity fractures had lower odds of deferred surgery (3.8% vs. 26.8%; aOR 0.08; 95% CI 0.03-0.22), higher odds of open reduction (11.2% vs. 2.4%; aOR 4.26; 95% CI 1.02-17.74), and higher odds of inpatient admission (81.2% vs. 42.7%; aOR 6.29; 95% CI 3.35-11.79). The overall complication rate was 2.1%. Fracture severity was the dominant predictor of surgical approach, consistent with its established role in operative planning. Operative timing and inpatient admission reflected both clinical severity and logistical presentation factors, suggesting that their intersection-rather than severity alone-shapes the downstream care pathway. Gartland severity may serve as a practical triage signal to support operating room scheduling and bed planning at paediatric referral centres.