Journal of Children's Orthopaedics - 2026-03-29 - Journal Article
Open supracondylar humerus fractures in children: Associated injuries and clinical outcomes.
Emet A, Armet G, Luck C, Aksoy T, Mendelson SA, Dede O
Topics
Key Takeaway
Open supracondylar humerus fractures represent 1.1% of all pediatric SCH fractures and carry a 20.6% nerve injury rate and 26.5% reoperation rate.
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Summary
This single-institution retrospective study evaluated the incidence, associated injuries, and outcomes of open pediatric SCH fractures over a 20-year period. All 34 patients underwent irrigation and debridement with open-assisted reduction and K-wire fixation; 91.2% were Gartland Type III and 44.1% were Gustilo-Anderson Type II. Nerve injury occurred in 20.6%, vascular repair was required in 5.9%, 26.5% required reoperation, and 26.5% had ≥10° flexion-extension ROM deficit.
Key Limitation
The 20-year study window spans significant evolution in surgical technique and implant use without stratification by era, potentially conflating outcomes across meaningfully different practice environments.
Original Abstract
PURPOSE
Supracondylar humerus (SCH) fractures are common, but they rarely present as open fractures. This study aimed to evaluate the incidence, associated injuries, and postoperative outcomes of open SCH fracture management in the pediatric population.
METHODS
Children with open SCH fractures treated at a single institution between January 2005 and January 2025 were included in this study. Electronic medical records were reviewed to collect demographic data, fracture characteristics, surgical details, and postoperative outcomes. All patients underwent wound irrigation and debridement, open-assisted reduction, and K-wire fixation under general anesthesia. Postoperative care included immobilization, follow-up for fracture healing and range of motion (ROM), and selective physical therapy. Data were analyzed using standard statistical methods, with significance set at p < 0.05.
RESULTS
Among 3053 SCH fractures, 1.1% were open fractures (15 males, 19 females), with a mean age of 7.7 ± 2.4 years. The nondominant left arm was affected in 82.4% of cases, and the most common mechanism of injury was a fall from height (64.7%). Extension-type modified Gartland type III fractures were observed in 91.2% of patients, and Gustilo-Anderson type II was the most frequent open fracture classification (44.1%). Associated nerve injuries occurred in 20.6% of patients, and vascular repair was required in 5.9%. The mean time to pin removal was 4.7 ± 1 weeks. Overall, 26.5% of patients underwent reoperation, 26.5% experienced ≥10° reduction in flexion-extension ROM.
CONCLUSION
Open SCH fractures are rare yet serious injuries, causing peripheral nerve and vascular damage that require surgical repair.