Fracture Patterns, Skeletal Age, and Outcomes in Adolescent Supracondylar Humerus Fractures Treated With Open Reduction Internal Fixation.

BACKGROUND

Supracondylar humerus fractures (SCHF) in adolescents transitioning to skeletal maturity are less common, and literature on the management of complex cases with open reduction internal fixation (ORIF) is limited. The objective of this study was to retrospectively evaluate SCHFs treated with ORIF at a single tertiary pediatric center.

METHODS

Patients of ages 7-18 who received ORIF between 2015 and 2024 for SCHF with intercondylar extension (T-type; OTA/AO 13-E/4.2) or extraarticular SCHF (eSCHF; OTA/AO 13-M/3.1, 13/E/1.1) were included. Patients treated with percutaneous pinning alone or with prior elbow fractures were excluded. Demographic characteristics, skeletal age, injury mechanism, fracture morphology, and fixation strategy were compared. Outcomes included fracture union, range of motion (ROM), and complications. Stiffness was defined using Morrey's criteria. Final ROM was graded as defined by Jarvis et al.

RESULTS

Twenty-eight patients (12.7 years, 45% Female) were included and represented 3% of SCHFs in this age range. The T-type group (n = 14) was older and more skeletally mature (modified Sauvegrain score 6.8 vs 4.5; P = .003) than the eSCHF group. Plate and screw constructs were preferred in T-type fractures (9/14, 64%), while 79% (11/14) of eSCHF received cannulated screws (P = .008). All fractures achieved union (mean 11 wks). The T-type group was immobilized for a shorter period (2.3 vs 3.2 weeks; P = .043) and had more stiffness at 3 months (50 vs 9%; P = .042), but the difference in arc of motion at final follow-up did not reach statistical significance (133 vs eSCHF 142 deg; P = .07). The ROM in T-type fractures did not differ by construct type. Most patients (n = 18, 64%) were skeletally advanced compared to their chronological age (range 6-30 months). Complication rate was high (64%) primarily from hardware pain (9; 32%).

CONCLUSIONS

T-type SCHF were seen in skeletally mature patients and were associated with slower ROM recovery. Fixation strategy was correlated with fracture type. There were no significant differences in clinical outcomes between the two fixation methods. Future prospective studies are warranted to optimize the treatment of adolescent SCHF injuries.

KEY CONCEPTS: (1)Patients with SCHF with intraarticular extension were older and more skeletally mature.(2)Plate and screws were preferred over cannulated screws for intraarticular extension.(3)All fractures achieved union and final arc of motion did not differ by fracture type.(4)Elbows with T-type fractures were immobilized 1 week less but stiffer at 3-months.(5)Complication rate was high at 64%, and half were due to hardware pain.

LEVEL OF EVIDENCE: III, Retrospective Cohort Study.