The Role of Patient Position in the Surgical Treatment of Supracondylar Fractures of the Humerus: Comparison of Prone and Supine Position

Abstract

Background and Objectives: Supracondylar fractures of the humerus (SCHF) make up about one-third of pediatric fractures and are the most common elbow fractures in children. Reduction and fixation of SC fractures can be performed with the patient in the prone or supine position. However, the role of the patient’s position during surgery is still unclear. The purpose of this systematic review is to evaluate, based on data from the literature, the role of patient position during closed reduction and fixation of pediatric SCHFs. Materials and Methods: A systematic review of the current literature from 1951 to 2021 was conducted according to PRISMA guidelines. Articles were identified from 6 public databases. Articles were screened and abstracted by two investigators and the quality of included publications (n = 14) was assessed (MINORS criteria). Statistical analyses were performed using R studio 4.1.2. Results: The systematic literature review identified 114 articles, from which, according to inclusion and exclusion criteria, 14 studies were identified. A total of 741 children were treated in the prone position and 538 in the supine position. The results of the systematic review showed that there were no statistical differences between the two positions with regard to clinical, radiographic, and complication outcomes. Conclusions:: The functional and radiographic outcome of displaced SCHFs is generally excellent regardless of the position, prone or supine, in which the patient is positioned for surgery. The choice of how to position the patient depends on the habit and experience of the surgeon and anesthesiologist performing the surgery.

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

“…In this study, all children who received surgery were operated on in the supine position. In the literature, no differences have been described in terms of functional and radiological outcomes between prone and supine positioning, and positioning is dependent on the habits and experience of the surgeons and anesthesiologists [ 40 ]. In addition, this study showed that although the majority of patients were clinically fully functional at the end of their treatment, functional and neurological deficits scarcely occurred in type I fractures.…”

Pediatric Supracondylar Fracture of the Humerus with Sideward Displacement

“…While the supine position is most often used for supracondylar humeral fracture reduction, both supine and prone positioning of the patient has been used. A recent systematic review showed comparable results for closed reduction and pinning in both positions [19]. However, as sideward displaced fractures may require switching to open reduction, we do not recommend using prone positioning for this fracture subtype.…”

Use of lateral-exit crossed-pin fixation for pediatric supracondylar humeral fractures: a retrospective case series

“…The latter arises from kinking or tangling of soft tissues against the pin in the process of pin insertion [20]. The well-known techniques to reduce the risk of iatrogenic ulnar nerve injury, including the miniopen approach over the medial epicondyle [10], intraoperative prone positioning [22,23], and Mubarak and Davids' maneuver [14,15], are designed to prevent direct penetration of the ulnar nerve. The rationale behind the Mubarak and Davids' maneuver is based on the tendency of the ulnar nerve to migrate over the anterior to the medial epicondyle when the elbow is hyperflexed >90° [19][20][21]24].…”