Predictors Associated with the Need for Open Reduction of Pediatric Supracondylar Humerus Fractures: A Meta-analysis of the Recent Literature

M Bryant Transtrum; Diego Sanchez; Shauna Griffith; Brianna Godinez; Vishwajeet Singh; Kyle J Klahs; Amr Abdelgawad; Ahmed M Thabet

doi:10.2106/JBJS.OA.24.00011

Predictors Associated with the Need for Open Reduction of Pediatric Supracondylar Humerus Fractures: A Meta-analysis of the Recent Literature

JB JS Open Access. 2024 Aug 6;9(3):e24.00011. doi: 10.2106/JBJS.OA.24.00011. eCollection 2024 Jul-Sep.

Authors

M Bryant Transtrum¹, Diego Sanchez², Shauna Griffith³, Brianna Godinez⁴, Vishwajeet Singh⁵, Kyle J Klahs⁴, Amr Abdelgawad⁶, Ahmed M Thabet⁴

Affiliations

¹ Department of Emergency Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, Texas.
² Department of Emergency Medicine, University of New Mexico, Albuquerque, New Mexico.
³ Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, Texas.
⁴ Department of Orthopaedic Surgery and Rehabilitation, Texas Tech University Health Sciences Center El Paso, El Paso, Texas.
⁵ Office of Research, Biostatistics, and Epidemiology Consulting Lab, Texas Tech University Health Sciences Center El Paso, El Paso, Texas.
⁶ Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York.

Abstract

Background: Supracondylar humerus (SCH) fractures are some of the most common fractures in pediatric patients with surgery typically consisting of either open or closed reduction with internal fixation. The aim of this meta-analysis was to identify patient, injury, and administrative factors that are associated with treating pediatric SCH fractures with open techniques.

Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, PubMed and CINAHL database searches were conducted for studies from 2010 to 2023 that made direct comparisons between open reduction and internal fixation (ORIF) and closed reduction and percutaneous pinning (CRPP) for treating SCH fractures in the pediatric population. The search terms used were "pediatric" AND "SCH fracture" OR "distal humerus fracture." Screening, quality assessment, and data extraction were performed by 4 reviewers. After testing for heterogeneity between studies, data were aggregated using random-effects model analysis.

Results: Forty-nine clinical studies were included in the meta-analysis. Summated, there were 94,415 patients: 11,329 treated with ORIF and 83,086 treated with CRPP. Factors that were significantly associated with greater rates of ORIF included obesity (p = 0.001), Gartland type IV fractures (p < 0.001), general neurological deficits (p = 0.019), and ulnar nerve deficits (p = 0.003). Gartland type II (p = 0.033) and medially displaced fractures (p = 0.011) were significantly associated with lower rates of ORIF. Secondary analysis showed cross-pinning constructs (p = 0.033) and longer hospital stays (p = 0.005) are more likely to be observed in patients undergoing ORIF compared with CRPP.

Conclusion: This meta-analysis demonstrates that factors such as obesity, fracture displacement, and concomitant nerve deficits are more likely to require ORIF as opposed to CRPP.

Level of evidence: Therapeutic Level III.

Publication types

Review