Open supracondylar humerus fractures in children: Associated injuries and clinical outcomes.

Abstract

Purpose: Supracondylar humerus (SCH) fractures are common, but they rarely present as open fractures. This study aimed to evaluate the incidence, associated injuries, and postoperative outcomes of open SCH fracture management in the pediatric population.

Methods: Children with open SCH fractures treated at a single institution between January 2005 and January 2025 were included in this study. Electronic medical records were reviewed to collect demographic data, fracture characteristics, surgical details, and postoperative outcomes. All patients underwent wound irrigation and debridement, open-assisted reduction, and K-wire fixation under general anesthesia. Postoperative care included immobilization, follow-up for fracture healing and range of motion (ROM), and selective physical therapy. Data were analyzed using standard statistical methods, with significance set at p < 0.05.

Results: Among 3053 SCH fractures, 1.1% were open fractures (15 males, 19 females), with a mean age of 7.7 ± 2.4 years. The nondominant left arm was affected in 82.4% of cases, and the most common mechanism of injury was a fall from height (64.7%). Extension-type modified Gartland type III fractures were observed in 91.2% of patients, and Gustilo-Anderson type II was the most frequent open fracture classification (44.1%). Associated nerve injuries occurred in 20.6% of patients, and vascular repair was required in 5.9%. The mean time to pin removal was 4.7 ± 1 weeks. Overall, 26.5% of patients underwent reoperation, 26.5% experienced ≥10° reduction in flexion-extension ROM.

Conclusion: Open SCH fractures are rare yet serious injuries, causing peripheral nerve and vascular damage that require surgical repair.