Correlation of Fall Height, Fracture Severity and Clinical Outcome in Pediatric Supracondylar Fractures—A Retrospective Analysis with an Observation Period of 20 Years

Abstract

The most common cause leading to supracondylar humerus fractures in children is falling onto an outstretched arm. A correlation between fall height and fracture severity may be assumed but has not yet been described. The aim of this study was to show that fracture severity increases with fall height. Furthermore, the correlation between fracture severity and outcome was examined. A total of 971 children with supracondylar humerus fractures between January 2000 and December 2019 were included in this study. The correlations between fall height and fracture severity and between fracture severity and outcome were assessed. Increasing fall height correlates with fracture severity (p < 0.001; r = 0.24). Furthermore, the incidence of complications increases with fracture severity and a correlation was present accordingly (p < 0.001; r = 0.28). A total of 30 (3.1%) patients showed limitations in range of motion and/or persistent neurologic deficits at the latest follow-up. Type I fractures rarely lead to subsequent limitations. The correlation between increasing fall height and fracture severity was significant. Furthermore, children with type III and IV supracondylar fractures are more likely to develop complications or restrictions in movement than children with type I and II fractures. Hence, the initial fall height may be an indirect indicator of a more or less favorable outcome.

Epidemiology of Supracondylar Fractures of the Humerus in Children

“…For our analysis, we categorized fractures based on fall height: a short distance or standing height (<1 m) or from a greater height (>1 m). We observed that the more severe fractures were statistically associated with falls from great heights, a finding that is consistent with those of Schuller et al 3 , who found that type I fractures typically occur during falls from standing height, while the severity of fractures seems to increase with fall height per the Gartland classification 3 .…”

“…Given the increasing incidence of supracondylar fractures of the humerus in children in recent years 3,14 , it is crucial to understand the epidemiological profile of these fractures across different regions of Brazil. With this aim, the present study undertook an epidemiological analysis of patients treated at a referral pediatric hospital in northeastern Brazil.…”

“…Previous studies reported an average age of patients with supracondylar humerus fractures of 5-7 years 1,3,4,13 . This aligns with our study findings of an average age of 5.4 (2.4) years.…”

“…However, it is the most prevalent fracture among children aged 4-7 years 2 . Over recent decades, there has been an approximately 7% increase in the incidence of this fracture type 3 .…”

“…Supracondylar fractures predominantly occur in boys [3][4][5][6][7] and are more common on the left or non-dominant limb 5 . They can result from both low-energy impacts, such as falls from standing height, or high-energy traumas, such as those associated with sports activities.…”