Examining Outcomes for Operative versus Non-operative Treatment of Pediatric Type II Supracondylar Humerus Fractures: A Systematic Review

Objective(s): To examine various outcomes and complications in the literature associated with non-operative versus operative care for type II supracondylar humerus fractures (SCHF) in pediatric patients to guide surgeon decision-making and optimize patient care.

Data Sources: PubMed, Web of Science, MEDLINE, and CINAHL were searched from database inception until February 7th, 2024.

Study Selection: Articles were screened by two authors. Inclusion criteria were articles that examined pediatric patients, examined type II SCHF, had English full-text, and compared operative versus non-operative care. Seven articles met inclusion criteria for this study out of 417 articles initially retrieved.

Data Extraction: Data extraction was performed by three authors. Data recorded included study type, study group by treatment type, patient population, diagnosis, number of patients, male/female status, mean patient age, treatment descriptions, follow-up time, and total and specific complications.

Data Synthesis: Numerous studies revealed similar values between treatment groups for carrying angle, Baumann’s angle, elbow range-of-motion, and patient reported function/satisfaction. Regardless of treatment, patients had low rates of avascular necrosis and loss of reduction, but non-operative treatment was associated with a higher rate of residual deformity in the sagittal plane of the distal humerus (14.1% versus 0.0%; p< 0.0001). Failure of non-operative treatment requiring conversion to operative treatment occurred in 8.9-20.6% of patients. Factors associated with operative care were rotational deformity, varus/valgus malalignment, and shaft-condylar angle < 30°.

Conclusions: Higher rates of sagittal deformity are associated with non-operative management of type II SCH fractures. However, the functional implications of this remain unclear as both operatively and nonoperatively treated patients have similar elbow range of motion, function, and satisfaction. Further studies should seek to identify anatomic specific parameters that identify those at risk of poor functional outcomes or are at higher risk of failing non-operative management.

Author(s) Disclosures: The authors have no relevant disclosures to make known.