Athanaselis ED, Metaxiotis N, Rigopoulos N, Hantes M, Dailiana ZH, Karachalios T, Varitimidis S. Open reduction can be a reasonable, safe and effective choice in complex paediatric supracondylar humeral fractures operative treatment. World J Orthop 2025; 16(10): 110461 [DOI: 10.5312/wjo.v16.i10.110461]
Corresponding Author of This Article
Efstratios D Athanaselis, MD, PhD, Senior Consultant, Department of Orthopaedic Surgery and Musculoskeletal Trauma, University General Hospital of Larissa, 3 Panepistimiou Street, Biopolis, Larissa 41110, Greece. strts.a@gmail.com
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Orthopedics
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Retrospective Study
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Oct 18, 2025 (publication date) through Oct 26, 2025
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World Journal of Orthopedics
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2218-5836
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Athanaselis ED, Metaxiotis N, Rigopoulos N, Hantes M, Dailiana ZH, Karachalios T, Varitimidis S. Open reduction can be a reasonable, safe and effective choice in complex paediatric supracondylar humeral fractures operative treatment. World J Orthop 2025; 16(10): 110461 [DOI: 10.5312/wjo.v16.i10.110461]
World J Orthop. Oct 18, 2025; 16(10): 110461 Published online Oct 18, 2025. doi: 10.5312/wjo.v16.i10.110461
Open reduction can be a reasonable, safe and effective choice in complex paediatric supracondylar humeral fractures operative treatment
Efstratios D Athanaselis, Nikolaos Metaxiotis, Nikolaos Rigopoulos, Michael Hantes, Zoe H Dailiana, Theofilos Karachalios, Sokratis Varitimidis
Efstratios D Athanaselis, Nikolaos Metaxiotis, Nikolaos Rigopoulos, Michael Hantes, Zoe H Dailiana, Theofilos Karachalios, Sokratis Varitimidis, Department of Orthopaedic Surgery and Musculoskeletal Trauma, University General Hospital of Larissa, Larissa 41110, Greece
Author contributions: Athanaselis ED conceived the study and took the lead in writing the manuscript; Metaxiotis N collected the data, performed the analysis, and drafted the manuscript; Rigopoulos N contributed to the interpretation of the results and to the final version of the manuscript; Hantes M, Dailiana ZH, and Karachalios T contributed to the design and implementation of the research and to the analysis of the results; Varitimidis S supervised the project; and all authors discussed the results and contributed to the final manuscript providing critical feedback.
Institutional review board statement: This study was approved by the Medical Ethics Committee of University Hospital of Larissa.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after legal guardian of each underage patient agreed to treatment by written consent.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Raw data were generated at University Hospital of Larissa-Greece. Derived data supporting the findings of this study are available from the corresponding author on request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Efstratios D Athanaselis, MD, PhD, Senior Consultant, Department of Orthopaedic Surgery and Musculoskeletal Trauma, University General Hospital of Larissa, 3 Panepistimiou Street, Biopolis, Larissa 41110, Greece. strts.a@gmail.com
Received: June 10, 2025 Revised: June 30, 2025 Accepted: September 2, 2025 Published online: October 18, 2025 Processing time: 132 Days and 1.6 Hours
Abstract
BACKGROUND
Supracondylar humeral fractures are among the most common paediatric injuries. Displacement and consequent need for reduction impose operative treatment. Restoration of the anatomy of the distal part of the humerus prevents deformities and functional disorders of the elbow and upper limb. Stable K-wire fixation can be succeeded either by closed or open reduction method.
AIM
To investigate the safety and efficacy of open reduction method in the operative treatment of Gartland type III and IV supracondylar humeral fractures in children.
METHODS
We retrospectively studied 131 cases of paediatric supracondylar humerus fractures of Gartland type III-IV treated operatively by open reduction and pinning between 2001 and 2023 in our department. All patients underwent clinical and radiological examination recording elbow range of motion, function and deformity.
RESULTS
The standard lateral approach was carried out in all patients while in 47 cases (35.9%) additional medial approach was used. Average follow-up time was 5.4 years (1-14 years). Fracture healing was completed at 4-6 weeks. The average operative time was 50 min (range: 37-75 minutes, SD: 11.307) and the average duration of radiation exposure based on image intensifier usage time was 20 seconds (range: 7-45 seconds, SD: 9.864). No infections or iatrogenic neurovascular complications were recorded and the functional outcome regarding range of motion, Patient-Reported Outcome Measures (Disabilities of the Arm, Shoulder, and Hand questionnaire, Mayo Elbow Performance Scores) at 2-year follow-up was satisfying.
CONCLUSION
Open reduction and K-wire fixation provide very satisfactory outcome in supracondylar fractures of the humerus in children with reduced radiation burden. Moreover, the risk of neurovascular injuries due to manipulations of closed reduction, is minimized while complications related to surgical approaches are insignificant provided there is expertise.
Core Tip: Complex supracondylar humeral fractures in children are treated operatively. Though closed reduction by Blount’s method and pinning is the treatment of choice, open reduction can be reasonable in cases of gross displacement, neurovascular compromise and difficulty in closed reduction. Intra- and post-operative complication rates, functional outcome and reduce in radiation burden define open reduction as a safe and effective operative method.
