A novel external-fixation technique for delayed, nonreducible Gartland type III supracondylar humerus fractures in children

Background Percutaneous pinning is widely recognized as the gold-standard approach for managing supracondylar humerus fractures (SHFs) in pediatric patients. However, manual reduction of delayed SHFs can present significant challenges, and repeated attempts may result in iatrogenic injuries. Additionally, immobilizing the edematous elbow joint with a cast carries the risk for Compartment Syndrome. To address these concerns, we implemented a medial mini-open approach combined with external fixation. Materials and Methods The treatment outcomes of 32 patients treated with external fixation frames between 2015 and 2023 were analyzed. These outcomes encompassed limb alignment, elbow movement, appearance, and patient satisfaction. Results The resetting process was more direct in the open reduction than in the closed reduction and resulted in satisfactory reductions in all the patients, who achieved a normal or good range of motion. According to Flynn’s criteria, 30 patients showed a favorable prognosis, and 20 of them were classified as excellent. Both the patients and their parents expressed that they would choose this treatment approach again. Conclusion To treat delayed SHFs, utilization of medial mini-open reduction alongside external fixation appears to be a safe and efficacious approach.