Impact of surgical timing on effectiveness of closed reduction and percutaneous Kirschner wire fixation for pediatric supracondylar humerus fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

PAN Tianlong , HOU Xianghua ,  ZHANG Jingdong

Department of Pediatric Orthopedics, Wenzhou Medical University Affiliated Second Hospital and Yuying Children's Hospital, Wenzhou Zhejiang, 325100, P. R. China;

Corresponding author：

ZHANG Jingdong, Email: 3518478219@qq.com

Keywords：

Children; supracondylar humerus fracture; surgical timing; closed reduction; percutaneous Kirschner wire fixation; effectiveness

DOI：

10.7507/1002-1892.202503106

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Objective To compare the effectiveness of early versus delayed closed reduction and percutaneous Kirschner wire fixation in the treatment of pediatric supracondylar humerus fractures. Methods A retrospective analysis was conducted on 468 children with supracondylar humerus fractures, who were admitted between January 2020 and December 2023 and met the inclusion criteria. Among them, 187 children were treated during 12 hours after injury (early operation group) and 281 were treated after 12 hours (delayed operation group). There was no significant difference between the two groups (P>0.05) in the gender, age, injury mechanism, fracture side and type, while there was significant in interval from injury to operation (P<0.05). The operative outcomes, including the operation time, intraoperative blood loss, hospital stay, fracture healing time, elbow function (assessed by Flynn criteria) at 3 months after operation, and complications, were compared. Results Compared to the delayed operation group, the early operation group demonstrated significantly shorter operation time and less intraoperative blood loss (P<0.05). There was no significant difference in the length of hospital stay between the two groups (P>0.05). All children were followed up 3-12 months. The follow-up time was (6.7±2.9) months in the early operation group and (6.9±2.8) months in the delayed operation group (P>0.05). There was no significant difference in the fracture healing time between the two groups (P>0.05). At 3 months after operation, the early operation group exhibited superior Flynn elbow functional outcomes to the delayed operation group (P<0.05). In the early operation group, there was 1 case of fracture non-union, and 3 cases of cubital varus deformity after operation. In the delayed operation group, there was 1 case of nerve injury, 7 cases of fracture non-union, and 12 cases of cubital varus deformity after operation. There was a significant difference in the incidence of complications between the two groups (P<0.05). One case of the early operation group and 10 cases of the delayed operation group were undergone secondary operation, sowing no significant difference in the incidence of secondary operation between the two groups (P>0.05). Conclusion For pediatric supracondylar humerus fractures, early closed reduction and percutaneous Kirschner wire fixation can reduce operation time, minimize intraoperative blood loss and postoperative complications, and improve the functional recovery compared to delayed operation.

1.	Duffy S, Flannery O, Gelfer Y, et al. Overview of the contemporary management of supracondylar humeral fractures in children. Eur J Orthop Surg Traumatol, 2021, 31(5): 871-881.
2.	Beaty JH, Kasser JR. Fractures about the elbow. Instr Course Lect, 1995, 44: 199-215.
3.	Gartland JJ. Management of supracondylar fractures of the humerus in children. Surg Gynecol Obstet, 1959, 109(2): 145-154.
4.	Shenoy PM, Islam A, Puri R. Current management of paediatric supracondylar fractures of the humerus. Cureus, 2020, 12(5): e8137. doi: 10.7759/cureus.8137.
5.	Leitch KK, Kay RM, Femino JD, et al. Treatment of multidirectionally unstable supracondylar humeral fractures in children. A modified Gartland type-Ⅳ fracture. J Bone Joint Surg (Am), 2006, 88(5): 980-985.
6.	Micheloni GM, Novi M, Leigheb M, et al. Supracondylar fractures in children: management and treatment. Acta Biomed, 2021, 92(S3): e2021015. doi: 10.23750/abm.v92iS3.11725.
7.	Bašković M, Pešorda D, Zaninović L, et al. Management of pediatric elbow fractures and dislocations. Children (Basel), 2024, 11(8): 906. doi: 10.3390/children11080906.
8.	Suganuma S, Tada K, Yasutake H, et al. Timing of surgery for pediatric supracondylar humerus fractures and early postoperative results. J Hand Surg (Asian Pac Vol), 2020, 25(2): 226-231.
9.	Li J, Rai S, Tang X, et al. Surgical management of delayed Gartland type Ⅲ supracondylar humeral fractures in children: A retrospective comparison of radial external fixator and crossed pinning. Medicine (Baltimore), 2020, 99(10): e19449. doi: 10.1097/MD.0000000000019449.
10.	Vaquero-Picado A, González-Morán G, Moraleda L. Management of supracondylar fractures of the humerus in children. EFORT Open Rev, 2018, 3(10): 526-540.
11.	Schmid T, Joeris A, Slongo T, et al. Displaced supracondylar humeral fractures: influence of delay of surgery on the incidence of open reduction, complications and outcome. Arch Orthop Trauma Surg, 2015, 135(7): 963-969.
12.	Han QL, Wang YH, Liu F. Comparison of complications and results of early versus delayed surgery for Gartland type Ⅲ supracondylar humeral fractures in pediatric patients. Orthop Surg, 2011, 3(4): 242-246.
13.	Flynn JC, Matthews JG, Benoit RL. Blind pinning of displaced supracondylar fractures of the humerus in children. Sixteen years' experience with long-term follow-up. J Bone Joint Surg (Am), 1974, 56(2): 263-272.
14.	倪宏强, 楼跃. 儿童肱骨髁上骨折的治疗进展. 临床小儿外科杂志, 2020, 19(4): 364-369,376.
15.	Paci GM, Tileston KR, Vorhies JS, et al. Pediatric supracondylar humerus fractures: does after-hours treatment influence outcomes? J Orthop Trauma, 2018, 32(6): e215-e220.
16.	Farrow L, Ablett AD, Mills L, et al. Early versus delayed surgery for paediatric supracondylar humeral fractures in the absence of vascular compromise: a systematic review and meta-analysis. Bone Joint J, 2018, 100-B(12): 1535-1541.
17.	Yildirim AO, Unal VS, Oken OF, et al. Timing of surgical treatment for type Ⅲ supracondylar humerus fractures in pediatric patients. J Child Orthop, 2009, 3(4): 265-269.
18.	Scherl SA, Schmidt AH. Pediatric trauma: getting through the night. Instr Course Lect, 2010, 59: 455-63.
19.	Mehlman CT, Strub WM, Roy DR, et al. The effect of surgical timing on the perioperative complications of treatment of supracondylar humeral fractures in children. J Bone Joint Surg (Am), 2001, 83(3): 323-327.

1. Duffy S, Flannery O, Gelfer Y, et al. Overview of the contemporary management of supracondylar humeral fractures in children. Eur J Orthop Surg Traumatol, 2021, 31(5): 871-881.
2. Beaty JH, Kasser JR. Fractures about the elbow. Instr Course Lect, 1995, 44: 199-215.
3. Gartland JJ. Management of supracondylar fractures of the humerus in children. Surg Gynecol Obstet, 1959, 109(2): 145-154.
4. Shenoy PM, Islam A, Puri R. Current management of paediatric supracondylar fractures of the humerus. Cureus, 2020, 12(5): e8137. doi: 10.7759/cureus.8137.
5. Leitch KK, Kay RM, Femino JD, et al. Treatment of multidirectionally unstable supracondylar humeral fractures in children. A modified Gartland type-Ⅳ fracture. J Bone Joint Surg (Am), 2006, 88(5): 980-985.
6. Micheloni GM, Novi M, Leigheb M, et al. Supracondylar fractures in children: management and treatment. Acta Biomed, 2021, 92(S3): e2021015. doi: 10.23750/abm.v92iS3.11725.
7. Bašković M, Pešorda D, Zaninović L, et al. Management of pediatric elbow fractures and dislocations. Children (Basel), 2024, 11(8): 906. doi: 10.3390/children11080906.
8. Suganuma S, Tada K, Yasutake H, et al. Timing of surgery for pediatric supracondylar humerus fractures and early postoperative results. J Hand Surg (Asian Pac Vol), 2020, 25(2): 226-231.
9. Li J, Rai S, Tang X, et al. Surgical management of delayed Gartland type Ⅲ supracondylar humeral fractures in children: A retrospective comparison of radial external fixator and crossed pinning. Medicine (Baltimore), 2020, 99(10): e19449. doi: 10.1097/MD.0000000000019449.
10. Vaquero-Picado A, González-Morán G, Moraleda L. Management of supracondylar fractures of the humerus in children. EFORT Open Rev, 2018, 3(10): 526-540.
11. Schmid T, Joeris A, Slongo T, et al. Displaced supracondylar humeral fractures: influence of delay of surgery on the incidence of open reduction, complications and outcome. Arch Orthop Trauma Surg, 2015, 135(7): 963-969.
12. Han QL, Wang YH, Liu F. Comparison of complications and results of early versus delayed surgery for Gartland type Ⅲ supracondylar humeral fractures in pediatric patients. Orthop Surg, 2011, 3(4): 242-246.
13. Flynn JC, Matthews JG, Benoit RL. Blind pinning of displaced supracondylar fractures of the humerus in children. Sixteen years' experience with long-term follow-up. J Bone Joint Surg (Am), 1974, 56(2): 263-272.
14. 倪宏强, 楼跃. 儿童肱骨髁上骨折的治疗进展. 临床小儿外科杂志, 2020, 19(4): 364-369,376.
15. Paci GM, Tileston KR, Vorhies JS, et al. Pediatric supracondylar humerus fractures: does after-hours treatment influence outcomes? J Orthop Trauma, 2018, 32(6): e215-e220.
16. Farrow L, Ablett AD, Mills L, et al. Early versus delayed surgery for paediatric supracondylar humeral fractures in the absence of vascular compromise: a systematic review and meta-analysis. Bone Joint J, 2018, 100-B(12): 1535-1541.
17. Yildirim AO, Unal VS, Oken OF, et al. Timing of surgical treatment for type Ⅲ supracondylar humerus fractures in pediatric patients. J Child Orthop, 2009, 3(4): 265-269.
18. Scherl SA, Schmidt AH. Pediatric trauma: getting through the night. Instr Course Lect, 2010, 59: 455-63.
19. Mehlman CT, Strub WM, Roy DR, et al. The effect of surgical timing on the perioperative complications of treatment of supracondylar humeral fractures in children. J Bone Joint Surg (Am), 2001, 83(3): 323-327.

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