Evaluation of Open versus Closed Reduction in Displaced Pediatric Distal Humerus Fractures: A Comparative Cohort Study

Abstract

Background: Displaced supracondylar fractures constitute the predominant distal humeral fracture pattern in children and may be complicated by malalignment, elbow stiffness, neurovascular injury, and residual deformity. Closed reduction with percutaneous pin fixation represents the preferred operative strategy for most displaced fractures; however, open reduction becomes necessary when satisfactory closed alignment cannot be obtained or when fracture configuration, soft-tissue interposition, open injury, or neurovascular compromise precludes safe closed management. This study compared clinical, functional, radiological, and perioperative outcomes following closed and open reduction of displaced pediatric distal humerus fractures.

Methods: A comparative cohort study was conducted at [Institution, City] during [study period]. Children aged 2-14 years with displaced Gartland type III or IV supracondylar fractures treated surgically were included. Patients were categorized according to definitive reduction technique into closed reduction with percutaneous pinning (CRPP) and open reduction with Kirschner-wire fixation groups. The primary outcome was satisfactory functional outcome according to Flynn criteria. Secondary outcomes included elbow range of motion, Baumann angle, union time, operative duration, hospital stay, infection, neurological complications, loss of reduction, and cubitus varus. Statistical significance was set at p<0.05.

Results: In the illustrative cohort of 102 children, 70 underwent closed reduction and 32 underwent open reduction. Satisfactory Flynn functional outcomes occurred in 66/70 (94.3%) patients after closed reduction and 28/32 (87.5%) after open reduction (p=0.255). Mean operative duration was significantly shorter with closed reduction (41.8 +/- 12.4 versus 67.3 +/- 18.6 minutes; p<0.001), as was hospital stay (1.8 +/- 0.7 versus 2.6 +/- 1.1 days; p<0.001). Mean final flexion loss was 6.2 +/- 5.1 degrees and 9.1 +/- 7.0 degrees, respectively (p=0.041). Baumann angle, fracture-union time, cosmetic Flynn outcome, loss of reduction, infection, nerve injury, and cubitus varus did not differ significantly.

Conclusion: Successful closed reduction with percutaneous fixation provided excellent functional and radiographic outcomes while reducing operative duration and hospitalization. Open reduction nevertheless produced satisfactory outcomes in most patients and remained an important definitive strategy for irreducible or complicated fractures. Treatment should therefore prioritize safe anatomic reduction rather than avoidance of open surgery when legitimate indications are present.