Comparison of Surgical Treatment Methods and Predictors of Postoperative Success in Pediatric Supracondylar Humerus Fractures

Purpose: In our study, we aimed to compare the outcomes of different intraoperative treatment methods for pediatric supracondylar humerus fractures and to identify predictive values affecting success. We conducted a detailed comparison of the Modified Flynn scoring, which has limited use in the literature, among different patient groups. We also shared the follow-up of nerve injuries. Thus, we aimed to provide guidance on the surgical approach to pediatric supracondylar humerus fractures. In addition, we evaluated whether medial pinning was necessary, considering the risk of ulnar nerve injury, with long-term follow-up results. Methods: The radiological, clinical, and functional outcomes of 78 pediatric patients who underwent surgery for supracondylar humerus fractures at our clinic between 2012 and 2021 were examined. Patients were classified according to their surgical technique, including closed or open reduction and single or double-column fixation. During the radiological examination, the Baumann angle, lateral humerocapitellar angle, and carrying angle were evaluated. Elbow range of motion and carrying angle were measured and evaluated according to the modified Flynn cosmetic and functional criteria. A comparison was made between the operated and intact arms. Results : K-wire removal time was shorter in patients with Gartland type 2 compared to types 3 and 4 (p=0.036). Patients who underwent closed surgery had shorter hospital stays (p<0.001). When comparing the groups with excellent and good results according to the Modified Flynn cosmetic score, carrying angle and supination were found to differ significantly (p=0.002, p<0.001). Flexion-extension and supination values were found to differ significantly between the excellent-good and fair-poor groups according to the Modified Flynn functional score (p<0.001, p=0.003). Modified Flynn cosmetic and functional scoring results were similar in long-term follow-up whether surgery was open or closed and whether single-column or double-column fixation was performed. Conclusion: The clinical, radiological, and functional outcomes of supracondylar humerus fractures fixed with open or closed reduction are similar. Whether the number of columns is single or double, the clinical, radiological, and functional outcomes are similar and satisfactory. Therefore, based on their experience and expertise, the surgeon can treat their patients with the surgical method they deem most effective. Unless medial column fixation is necessary for stability, it should be avoided to avoid ulnar nerve injury. This descriptive, retrospective study was planned as a medical specialization thesis at the Department of Orthopedics and Traumatology of Karadeniz Technical University(KTU) Farabi Hospital and was carried out with the approval of the Scientific Research Ethics Committee of KTU Faculty of Medicine dated 12.09.2022 and numbered 24237859-539 , protocol numbered 2023/178 regarding “medical ethical appropriateness. Sequence data that support the findings of this study have been deposited in the national thesis center. https://tez.yok.gov.tr/UlusalTezMerkezi/tezSorguSonucYeni.js