In the Treatment of Supracondylar Humerus Fractures, Open or Closed Reduction With Percutaneous Pinning Results in Comparable Pain Levels and Low Morphine Requirements.

Abstract

Background: Pediatric supracondylar humeral fractures often require surgical fixation through closed reduction and percutaneous pinning (CRPP) or open reduction and percutaneous pinning (ORPP). Concerns about postoperative opioid use in children necessitate evaluation of pain and analgesic requirements between the 2 techniques.

Methods: This single-center, retrospective cohort study included 207 patients aged 1 to 13 years or younger who underwent CRPP (n=167) or ORPP (n=40) between 2013 and 2025. Postoperative pain was assessed using the Face, Legs, Activity, Cry, and Consolability (FLACC) scale and the Numerical Pain Rating Scale (NPRS) at 9  PM on postoperative day 0 and 9 am on postoperative day 1. Analgesic administration, including opioid use and morphine milligram equivalents (MME), as well as rescue analgesics, was recorded. Demographic data, fracture type according to the Gartland classification, and intraoperative variables were collected. Comparisons between groups were performed using Mann-Whitney U and χ 2 tests, with significance defined as P <0.05.

Results: Postoperative pain scores were comparable between ORPP and CRPP groups on both day 0 (FLACC scale 2.5±0.8 vs. 2.7±1.2, P =0.613; NPRS 2.7±1.1 vs. 2.7±1.0, P =0.754) and day 1 (FLACC scale 1.6±2.1 vs. 1.8±1.1, P =0.108; NPRS 1.9±1.0 vs. 1.8±0.9, P =0.901). Overall, 16.4% of patients received opioids, with no significant difference in MME or opioid use between groups. The proportion of patients requiring rescue analgesics and the type of analgesics used were also similar.

Conclusion: ORPP and CRPP resulted in comparable postoperative pain and opioid requirements, indicating that the additional incision in ORPP does not increase postoperative pain in pediatric supracondylar humeral fractures.

Level of evidence: Level III.