O1062: Risk Factors for Open Reduction of Pediatric Supracondylar Humerus Fractures: A Multicenter Study

Background: While the majority of operative supracondylar humerus fractures (SHF’s) can be treated with closed reduction and pinning, some may require open reduction (OpRed). An understanding of which patients are at risk of requiring open treatment may benefit surgical planning and patient counseling. Many previous studies are limited to a single institution, which may affect results. The purpose of this study was to identify risk factors for OpRed in children undergoing fixation of SHF’s.

Methods: This retrospective cohort study included skeletally immature patients that underwent pinning of a SHF at four tertiary children’s hospitals. Skeletally mature patients or those requiring fixation with implants other than pins were excluded. Demographic, radiographic, and clinical data from the pre-operative period were reviewed. Univariate analysis was followed by multivariate regression to adjust for confounders [reported with odds ratio (OR) and 95% confidence interval (CI)].

Results: A total of 2929 patients were included, of which 129 (4.4%) underwent open treatment. The median age for children that required OpRed was 6.6 years [interquartile range (IQR) 3 years] compared to 5.2 years (IQR 3 years) for those that did not. Flexion SHF underwent OpRed more frequently than extension-type fractures (22.6% vs. 3.8%, p< 0.001). For extension-type fractures, the rate varied by Gartland classification: 0.7% for type II, 5.9% for type III, and 15.4% for type IV (p < 0.001). Patients with ulnar nerve palsies required open treatment in 46.2% of cases and open fractures in 52.9% of cases. When adjusting for confounders, including institution, each year of increasing age raised the odds of open reduction by 1.2 (CI 1.1-1.4). Additional risk factors included increasing age (OR 1.2, CI 1.1-1.4), ecchymosis (OR 3.3, CI 2.1-5.4), open fractures (OR 20.5, CI 8.3-50.4), flexion SHF (OR 5.7, CI 2.9-11.0), Gartland type IV vs. III (OR 2.5, CI 1.1-5.7) and II (OR 12.8, CI 4.2-38.5), and ulnar nerve deficit (OR 5.7, CI 2.9-11.0; p< 0.05 for all).

Conclusion: The overall rate of OpRed for a pediatric SHF was 4.4% in this multicenter study. Risk factors include increasing age, ecchymosis or ulnar nerve deficit on exam, open fractures, flexion SHF, and Gartland type III and IV fractures. These results may help with surgical planning and patient counseling.