Incidence, risk factors, and consequences of radiographic pin migration after pinning of pediatric supracondylar humeral fractures

The first analysis of a multicentre paediatric supracondylar humerus fracture (SCHF) registry by fracture type

INTRODUCTION

Supracondylar humerus fractures (SCHFs) represent a significant segment of paediatric bone injuries, posing unique challenges due to their potential for severe complications. This study aims to provide a detailed analysis of the surgically treated SCHF cases recorded in our registry.

MATERIALS AND METHODS

Prospectively collected data from seven institutes were retrospectively analysed using the Hungarian SCHF Registry, with data about surgically treated paediatric patients with SCHFs. We created three groups based on fracture type (Gartland IIA, IIB and III), and compared their preoperative, operative, and postoperative data. We analysed differences between the groups using the Chi-Squared test or Fisher's Exact test for categorical variables. The Kruskal-Wallis rank sum test was performed for continuous variables. If there was a significant difference between the groups, we conducted Dunn's post-hoc analysis.

RESULTS

The fracture type was available for 214 patients (Gartland IIA group contained 31, IIB 121, and III 62 children). Our investigation highlighted notable patterns: lower oxygen saturation levels at initial assessment correlated with higher fracture severity (p = 0.0125); Body Mass Index (BMI) did not significantly influence the type of fracture (p = 0.2254); neither the mechanism of injury (flexion vs. extension) (p = 0.5606), nor the initial radial pulse (p = 0.0647) showed significant difference; the complexity of fractures was directly proportional to operative time (p < 0.01); less severe fractures required longer time to heal before pin removal (p = 0.0125); while severe fractures showed a tendency towards neurological complications, the overall complication rates did not vary significantly across different fracture types (p = 0.0988).

CONCLUSIONS

Our study emphasizes the significance of initial oxygen saturation levels as potential indicators of fracture severity. It also stresses the need for detailed attention to neurological complications and the prolonged use of pins, thereby highlighting the importance of customized treatment strategies in paediatric SCHFs.

LEVEL OF EVIDENCE

II.