Operative Treatment of Pediatric Supracondylar Humerus Fractures Using Mini C-Arm Fluoroscopy.

Background: Supracondylar humerus (SCH) fractures comprise about 20% of pediatric fractures. Displaced SCH fractures require reduction and percutaneous pinning, most commonly making use of conventional C-arm (CCA) fluoroscopy. Many authors have proposed the use of mini C-arm (MCA) in the upper extremity, given multiple proposed benefits including decreased radiation. We investigated the utility of MCA in the operative treatment of pediatric SCH fractures.

Methods: Patients who underwent operative fixation of SCH fractures using MCA from 20202022 were reviewed. Demographic, surgical, and radiographic data were collected, along with clinical outcomes through final follow-up. Data were analyzed to assess rates of fluoroscopy use depending on various patient and fracture characteristics. Complication rates were quantified to assess the safety and efficacy of MCA for this procedure.

Results: 171 patients were included with an average age of 5.5 years. 55% of fractures were Gartland type 3/4, and most were treated with three lateral pins (69%). The median fluoroscopy time per case was 113 seconds with 61 images taken. Fluoroscopy use increased both with fracture severity and number of pins used. The overall complication rate was 2% with only one patient requiring reoperation (0.6%).

Conclusion: Utilizing MCA fluoroscopy in the treatment of SCH fractures is associated with a low rate of complications, consistent with previously reported rates when using CCA. We report a higher rate of fluoroscopy use compared to CCA which does not necessarily translate to an increase in radiation exposure. Utilizing MCA to surgically treat SCH fractures may have benefits over CCA, especially in certain practice settings.

Level of evidence: IV.