The medial-first approach in unstable pediatric supracondylar humerus fractures: association with reduced need for additional exposure and improved cosmetic outcomes.

PURPOSE: To compare the clinical, cosmetic, and surgical outcomes of medial-first and lateral-first open reduction approaches in the treatment of unstable pediatric supracondylar humerus fractures when closed reduction fails.

METHODS

In this retrospective comparative study, 68 pediatric patients (aged 2-10 years) with Gartland Type III and IV supracondylar humerus fractures requiring open reduction were evaluated. Patients were divided into two groups based on the initial surgical approach: medial-first (n = 31) and lateral-first (n = 37). Demographic characteristics, surgical time, pin configuration, range of motion, Flynn's functional and cosmetic outcomes, and postoperative complications were compared between groups.

RESULTS

The medial-first group demonstrated significantly shorter surgical time (55.5 +- 16.0 vs. 72.0 +- 20.2 minutes, p < 0.001) and superior cosmetic outcomes (excellent cosmetic Flynn's scores in 83.9% vs. 62.2%, p = 0.0408). The need for an additional incision was markedly higher in the lateral-first group (0 vs. 18 patients, p < 0.00001). Functional outcomes and complication rates were comparable between groups.

CONCLUSION

The medial-first approach in unstable pediatric supracondylar humerus fractures provides advantages in surgical efficiency and cosmetic outcomes, while minimizing the need for secondary incisions. It represents a safe and effective option for achieving stable fixation when closed reduction is unsuccessful.