Journal of Pediatric Orthopaedics - 2026-03-03 - Journal Article
In the Treatment of Supracondylar Humerus Fractures, Open or Closed Reduction With Percutaneous Pinning Results in Comparable Pain Levels and Low Morphine Requirements.
Chang WH, Wu KY, Chen YW, Wang CH, Hsu KL, Shih CA, Hong CK
Topics
Key Takeaway
ORPP and CRPP for pediatric supracondylar humerus fractures produce equivalent postoperative pain scores (FLACC 2.5 vs. 2.7, p=0.613) and opioid use, with only 16.4% of all patients requiring any opioid.
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Summary
This single-center retrospective cohort compared postoperative pain and opioid consumption between CRPP and ORPP in 207 pediatric patients (age 1–13) with supracondylar humerus fractures from 2013–2025. Pain was assessed via FLACC and NPRS at two postoperative time points; MME and rescue analgesic use were recorded. No significant differences were found in pain scores, opioid use rate (16.4% overall), or MME between groups, indicating the open incision required for ORPP does not independently drive greater postoperative pain.
Key Limitation
The ORPP cohort is disproportionately small (n=40 vs. n=167) and inherently represents more complex or irreducible fractures, introducing confounding that retrospective statistical adjustment cannot fully resolve.
Original Abstract
BACKGROUND
Pediatric supracondylar humeral fractures often require surgical fixation through closed reduction and percutaneous pinning (CRPP) or open reduction and percutaneous pinning (ORPP). Concerns about postoperative opioid use in children necessitate evaluation of pain and analgesic requirements between the 2 techniques.
METHODS
This single-center, retrospective cohort study included 207 patients aged 1 to 13 years or younger who underwent CRPP (n=167) or ORPP (n=40) between 2013 and 2025. Postoperative pain was assessed using the Face, Legs, Activity, Cry, and Consolability (FLACC) scale and the Numerical Pain Rating Scale (NPRS) at 9 PM on postoperative day 0 and 9 am on postoperative day 1. Analgesic administration, including opioid use and morphine milligram equivalents (MME), as well as rescue analgesics, was recorded. Demographic data, fracture type according to the Gartland classification, and intraoperative variables were collected. Comparisons between groups were performed using Mann-Whitney U and χ2 tests, with significance defined as P<0.05.
RESULTS
Postoperative pain scores were comparable between ORPP and CRPP groups on both day 0 (FLACC scale 2.5±0.8 vs. 2.7±1.2, P=0.613; NPRS 2.7±1.1 vs. 2.7±1.0, P=0.754) and day 1 (FLACC scale 1.6±2.1 vs. 1.8±1.1, P=0.108; NPRS 1.9±1.0 vs. 1.8±0.9, P=0.901). Overall, 16.4% of patients received opioids, with no significant difference in MME or opioid use between groups. The proportion of patients requiring rescue analgesics and the type of analgesics used were also similar.
CONCLUSION
ORPP and CRPP resulted in comparable postoperative pain and opioid requirements, indicating that the additional incision in ORPP does not increase postoperative pain in pediatric supracondylar humeral fractures.
LEVEL OF EVIDENCE
Level III.