Early versus delayed reduction and pinning of type III displaced supracondylar fractures of the humerus in children: A comparative study

Objectives: To determine whether children with Type III displaced supracondylar fractures of the humerus that were pinned in a delayed fashion, defined as more than eight hours after fracture, had a greater need for open reduction than patients with similar fractures pinned more urgently, within eight hours after the trauma. Also. to determine whether those patients treated later fared any worse than patients treated earlier. Design: Retrospective review of consecutive patients. Setting: Level I pediatric trauma center at a tertiary children's hospital. Patients: Fifty-eight consecutive patients, twenty-three with early pinning and thirty-five with delayed pinning. A subgroup of sixteen patients was followed for detailed clinical outcome. Intervention: Closed or open reduction and percutaneous pinning Main Outcome Measurements: Need for open reduction in either group. A separate subgroup was examined for carrying angle and evidence of low-grade compartment syndrome (such as grip strength and range of motion). Results: There was no difference in the need for open reduction in the group that was delayed and pinned more than eight hours following fracture. Follow-up examination showed no clinical difference between the two groups in any parameter measured. Conclusions: These results indicate that many supracondylar fractures of the humerus can be treated safely in a delayed manner with an excellent clinical result and without unduly prolonging the hospital slay (such as with traction). This allows the patient to be NPO and the surgeon to operate in daylight hours, saving time, hospital resources, and fatigue.