Risk factors of loss reduction after percutaneous fixation in supracondylar humerus in pediatric: a descriptive-analytical study

Abstract

Background & Aims: supracondylar humerus fracture is one of the most common pediatric elbow fractures accounting for about 16% of the pediatric fractures. Loss of reduction is one of the complications after closed and percutaneous fixation. This research is aimed to investigate the factors involved in the loss of reduction. Method: In this descriptive study, the children with supracondylar humerus fractures were examined. 175 children under the age of 10 with type 3 and 4 supracondylar humerus fracture fractures who underwent closed fixation and pinning were entered into the study. The studied factors were analyzed by a logistic regression method. Results: in this study 175 children under the age of 10 including 71 girls and 104 boys (59.4%) with the average age of 5.42.4 were investigated. In 153 cases, (87.4%) the fixation was anatomical and stable during the follow-up; while 22 cases (12.6%) had the loss of fixation. The most important anatomical disorder was internal rotation displacement in the medial distal part of fracture in these 22 cases. Pinning technique and obesity were among the effective factors in the failure of the anatomical reduction. In a way that obese children (above 85th percentile or IBM>25) and the lateral pinning location were divergent but they crossed in the fracture site and were effective with odd ratios of 1.3 (CI 95% 0.8-2.3) and 1.8 (CI 95% 0.9-2.3), respectively. In 14 cases (63.6%) the failure was due to the place of fracture cross and in 8 cases (36.6%) the complication occurred in the obese children. The fracture type had no effect on the loss of reduction as no difference was observed. Conclusions: Obesity and fixation technique are among the effective factors in the loss of reduction in pediatric supracondylar humerus fractures. In obese children, cross-suitable fixation should be considered to prevent complications.