Comparative Effectiveness of Closed Reduction With Percutaneous Pinning and Open Reduction With Internal Fixation in the Operative Management of Pediatric Type III Supracondylar Fractures

Abstract

BackgroundSupracondylar fracture with total displacement is classified as Gartland type 3. The operative management for this type of fracture can be closed reduction with percutaneous pinning (CRPP) or open reduction with internal fixation (ORIF). This study aims to determine whether CRPP or ORIF led to smaller changes in Baumann's angle, the carrying angle, loss of motion, and complication when treating pediatric supracondylar fractures. MethodologyIn a retrospective cohort design, pediatric patients presenting with supracondylar fractures at a tertiary care hospital in Bahrain between March and October of 2021 were enrolled. The collected data included age, gender, nationality, mechanism of injury, neurovascular status, type of surgery performed, follow-up period, range of motion, complications, Baumann's angle, carrying angle, and loss of motion. The changes in Baumann's angle, carrying angle, and reduction sufficiency were compared to the literature using Flynn's criteria for supracondylar fractures. ResultsThis study included the records of 60 patients with supracondylar fractures. In total, 28 patients underwent CRPP (group A), whereas 32 underwent ORIF (group B). A statistically significant difference (p = 0.037) between group A and group B was noted when combining the loss of carrying angle scores and the loss of motion scores to form the final Flynn score. In group A, 26 (92.8%) cases had satisfactory results; 75% of these cases were excellent or good. According to Flynn's criteria, all patients in group B were satisfactory; 93.75% of these cases were excellent or good. The loss of motion was significantly different between the two groups (p = 0.038). The mean loss of carrying angle was significantly different between the two groups, with 5.51 ± 3.03 degrees for group A and 4.23 ± 1.85 degrees for group B (p = 0.023). The study had only two cases with unsatisfactory ratings belonging to group A. ConclusionsIn pediatric patients presenting with type 3 supracondylar fractures, when compared to CRPP, ORIF was associated with less loss of motion, less loss of carrying angle, higher overall satisfactory results according to Flynn's criteria, and fewer complications.

Closed Reduction Percutaneous Pinning Compared With Open Reduction Internal Fixation In Treating Supracondylar Fractures: A Systematic Review

“…There was a significant difference comparing the two groups' methods in this study (p = 0.038). 11 Yaokreh et al, and Bahadur et al, found no significant difference between CRPP and ORIF. Yaokreh et al achieved 90.9 % versus 92 % satisfaction; P = 0.8835.…”

“…10 The loss of carrying angle was less than 5 degrees in all incidents, as demonstrated by Bahadur et al However, in the Abousaleh et al study, in the ORIF group, the loss of carrying angle was less (4.23 degrees) than in the CRPP group (5.51 degrees), with a statistically significant p = 0.023. 11 According to Shrestha et al, the mean Bauman's angle for the CRPP and ORIF groups was 16.89 and 18.88 degrees, respectively. Between CRPP and ORIF, significant difference (P = 0.142).…”

“…10 The mean Bauman's angle shift post-surgery and post-union in the Abousaleh et al, the study was 8.21±6.33 and 5.90±4.39 in the CRPP and ORIF groups, respectively, with p = 0.343. 11 Only three studies reported the incidence of complications following surgery. Yaokreh et al reported two problems and ten events in the ORIF and CRPP groups.…”

A Systemic Review of Adolescent Supracondylar Fractures: What Is the Surgical Treatment, Open Reduction With Internal Fixation (ORIF) or Closed Reduction With Percutaneous Pinning (CRPP)?

“…Neither method demonstrated a significant advantage over the other [ 3 ]. However, studies showed significantly better outcomes for children with Gartland type 3 SCH fractures treated with ORIF, reinforcing ORIF’s superiority over CRPP, albeit these studies had limited sample sizes [ 5 , 6 ].…”

Comparison of Efficacy between Open and Close Reduction in Supracondylar Fracture of Humerus in Children Using Flynn’s Criteria

“…The most vulnerable age been 4 to 11 years with 85% of the children to be suffering from supracondylar fracture. 1 Majority of these children have gender biased with male children been more vulnerable to fall and accidents than female children. [2][3][4] Children with SH fractures have a high risk of complicated fractures which required high skills for treatment.…”