Epidemiological Characteristics and Risk Factors for Closed Reduction Failure in Pediatric Extension-type Supracondylar Humerus Fractures: A Study from a Regional General Hospital

Background Supracondylar humerus fractures (SCHFs) are the most common pediatric elbow fractures, with extension-type fractures being the predominant subtype. While closed reduction and percutaneous pinning (CRPP) is the standard treatment for displaced extension-type SCHFs, failure of closed reduction remains a significant concern. Such failures often necessitate more invasive procedures and are associated with increased complications. Although previous studies have explored potential risk factors for closed reduction failure, comprehensive epidemiological data and consistent conclusions remain limited. This study aims to analyze the epidemiological characteristics and identify risk factors for closed reduction failure in pediatric extension-type SCHFs at a regional general hospital, providing evidence to enhance clinical management strategies. Study design A retrospective analysis was conducted on 981 pediatric patients diagnosed with extension-type SCHFs and treated at Third Hospital of Hebei Medical University between January 2016 and December 2022. Data on patient demographics, clinical characteristics, and surgical details were collected. Univariate and multivariate logistic regression analyses were performed to identify risk factors for closed reduction failure. Results Among the study cohort, 615 patients (62.69%) were male and 366 (37.31%) were female, with a mean age of 4.04 ± 2.61 years. The peak incidence was observed at five years of age, with a high-incidence plateau between three and seven years. Seasonal variations were noted, with a higher incidence in spring and summer. The overall success rate of closed reduction was 91.64%, whereas the failure rate was 8.36%. Multivariate logistic regression identified several significant independent risk factors for closed reduction failure: older age (OR = 2.705, 95% CI: [2.07, 3.53]), higher Gartland classification (OR = 5.048, 95% CI: [2.61, 9.76]), radial displacement (OR = 2.038, 95% CI: [1.46, 2.85]), and concomitant injuries (OR = 0.350, 95% CI: [0.19, 0.63]). Conclusion Extension-type SCHFs are most prevalent among preschool-aged children, particularly 5-year-old boys, with peak incidence occurring in spring and summer. Older age, higher Gartland classification, concomitant injuries, and radial displacement are significant independent risk factors for closed reduction failure. These findings highlight the necessity of individualized treatment strategies to optimize outcomes in pediatric SCHFs management and minimize the need for invasive interventions.