Comparison of Functional Outcome of Lateral versus Posterior Approach for the Treatment of Supracondylar Humeral Fracture in Children: A Systematic Review and Meta-Analysis

Abstract

Introduction: Supracondylar humeral fracture (SHF) is a common elbow injury in children, comprising 55-75% of distal humerus fractures. Most cases require surgical treatment, particularly in displaced fractures (Gartland type 3 or 4). While closed reduction and percutaneous pinning (CRPP) is the preferred approach, open reduction and internal fixation (ORIF) is required in certain cases, necessitating a choice between surgical techniques. However, there is no consensus on the optimal approach, particularly between the posterior and lateral methods .Methods: A systematic review was conducted according to PRISMA guidelines to compare the functional outcomes of lateral versus posterior surgical approaches for SHF in children. A comprehensive literature search of PubMed, Google Scholar, and Cochrane Library identified eligible studies from January 2015 to June 2022. Inclusion criteria encompassed randomized controlled trials and comparative studies evaluating functional outcomes. Data were analyzed using Review Manager 5.4, applying fixed or random effects models based on study heterogeneity.Results: Four studies met the inclusion criteria. The lateral approach demonstrated superior functional outcomes compared to the posterior approach, showing higher odds of excellent (OR 2.63, 95% CI [1.28-5.39]) and good (OR 1.12, 95% CI [0.51-2.17]) results. The posterior approach had shorter operative times but resulted in greater soft tissue damage and potential triceps weakness .Conclusion: Both lateral and posterior approaches yield satisfactory functional outcomes for SHF treatment in children. While the lateral approach offers better postoperative function and lower complication rates, the posterior approach provides a broader surgical field. Surgeon preference, expertise, and patient-specific considerations should guide the selection of the surgical approach. Further high-quality randomized trials are needed for definitive recommendations.