Journal of Pediatric Orthopaedics - 2026-05-05 - Journal Article
Daytime Versus After-hours Surgical Fixation of Pediatric Supracondylar Humeral Fractures: A Meta-analysis.
Boutros M, Awad G, Saad JP, Smadi Z, Masrouha K
Topics
Key Takeaway
After-hours CRPP for pediatric supracondylar humerus fractures produced comparable operative times, nerve injury rates, and open reduction rates versus daytime surgery, but alignment-related complications were significantly higher after-hours (P=0.04) across 913 patients.
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Summary
This meta-analysis asked whether surgical timing (daytime vs. after-hours) affects perioperative efficiency and complication rates for pediatric Gartland-type supracondylar humerus fractures requiring operative fixation. Seven comparative studies (n=913) were pooled from PubMed, Scopus, Cochrane, and Google Scholar through December 2025. Operative time (P=0.11), medial pin use (P=0.70), open reduction rate (P=0.80), infection, pin migration, and iatrogenic nerve injury were equivalent between groups, but alignment-related complications were significantly more frequent after-hours (P=0.04).
Key Limitation
The definition of 'after-hours' was not standardized across included studies, making it impossible to determine whether the alignment complication difference is driven by late-night fatigue, trainee involvement, staffing differences, or case acuity selection bias.
Original Abstract
BACKGROUND
Pediatric supracondylar humeral fractures (SCHFs) are among the most common elbow injuries in children and frequently require operative fixation. Although after-hours surgery is often unavoidable due to emergency presentation patterns, many centers now reserve nighttime intervention for urgent indications such as vascular compromise. Concerns nevertheless persist regarding the potential impact of after-hours surgery on surgical efficiency, technical decision-making, and postoperative outcomes.
METHODS
A systematic search of PubMed, Scopus, the Cochrane Library, and Google Scholar was conducted from database inception through December 15, 2025. Comparative studies evaluating operative treatment of pediatric SCHFs performed during daytime working hours versus after-hours were included. Outcomes assessed comprised perioperative characteristics (operative time, time to surgery), intraoperative decision-making (medial pin fixation, open reduction), and postoperative complications (pin migration, alignment-related complications, infection, and iatrogenic postoperative nerve injury).
RESULTS
Seven studies encompassing 913 pediatric patients met the inclusion criteria. Operative time did not differ significantly between daytime and after-hours surgery ( P =0.11). Time to surgery was shorter in the after-hours group ( P <0.001). No significant differences were observed in rates of medial pin fixation ( P =0.70) or open reduction ( P =0.80). Postoperative complications, including pin migration, infection, and iatrogenic postoperative nerve injury, were comparable between groups, whereas alignment-related complications were more frequent in the after-hours group ( P =0.04).
CONCLUSIONS
Operative fixation of pediatric SCHFs showed broadly comparable perioperative efficiency, technical outcomes, and complication rates when performed during daytime or after-hours, although alignment-related complications were more frequent in the after-hours group. These findings suggest that surgical timing alone may not be the primary determinant of outcome.