Risk Factors for Failed Closed Reduction of Pediatric Supracondylar Humerus Fractures

Abstract

The purpose of this retrospective study was to examine pediatric supracondylar humerus fractures at a Level I trauma center. Data were analyzed to identify risk factors associated with closed reduction failure. Closed pediatric supracondylar humerus fractures that were treated at the authors' trauma center between October 1997 and January 2009 were reviewed. The main outcome variable was necessity of open reduction. To determine which factors were independently associated with a failed closed reduction, a multivariate logistic model was fit predicting open reduction status.A total of 174 patients required operative treatment. Of these, 23 underwent open reduction and 151 underwent with closed reduction and percutaneous pinning. For patients who required open reduction, 39.1% had an associated injury compared with 14.6% of patients treated with closed reduction (P=.008). Average time from presentation to surgery was 4.1 hours in the open reduction and 6.3 hours in the closed reduction group (P=.049). Risk factors that significantly predicted failure of closed reduction were the presence of an associated injury, initial fracture displacement, and Gartland type III fracture (P=.008, .03, and .023, respectively).Associated injury, large initial fracture displacement, and Gartland type III factures were statistically significant independent risk factors for closed reduction failure. Increased time from injury to presentation demonstrated a trend toward open reduction. Consideration should be given to the expedient transfer of patients with type III supracondylar humerus fractures with associated injuries when definitive care will be provided at another institution.

A comparative study of two closed reduction methods for pediatric supracondylar humeral fractures

“…Pin site infection was the most frequent complication of the treatment of these fractures [11,13,20,21]. The reported rate of pin site infection ranged from 3.7% to 17.0% [11,13,14,22]. The incidence of it in our study was 8.4% (5/59), within the scope of rate reported in the previous papers [11,13,14,22].…”

“…The reported rate of pin site infection ranged from 3.7% to 17.0% [11,13,14,22]. The incidence of it in our study was 8.4% (5/59), within the scope of rate reported in the previous papers [11,13,14,22]. Moreover, malunion was another common complication, but there was significant variation among the different studies ranging from 1.0% to 20.8% [2,11,13,22,23].…”

“…To improve the success rate of closed reduction, some authors had proposed different joystick technique [1,2,13,14]. Novais EN et al [1] recommend placing a K-wire in the distal fragment from lateral to medial direction as a joystick for facilitating closed reduction.…”

“…As a result, how to get a satisfactory closed reduction poses a challenge to surgeons. To improve the success rate of closed reduction for supracondylar humeral fractures, surgeons have suggested some methods [1,2,13,14]. They usually use a Kirschner pin (or a Schanz pin) in the distal or proximal fragment of supracondylar humeral fractures as a joystick for facilitating closed reduction [1,2,13,14].…”

Adolescent Distal Humerus Fractures: ORIF Versus CRPP

“…Previous series show the rate of open reduction for failed closed treatment ranging from 0.46% to 46% with current studies placing the rate at about 13%. 19 The experience in this series of 7% is consistent with previously reported. Open treatment was secondary to failed closed reduction in 50% of the cases in the open treatment group, whereas the remaining patients were treated with planned rigid-fixation constructs.…”