Abstract
Background: Supracondylar humeral fracture (SHF) is the most common type of fracture in children. Moreover, lateral and posterior surgical approaches are the most frequently chosen approaches for open reduction surgery in displaced SHF when C-arm is unavailable. However, previous literature showed mixed findings regarding functional and cosmetic outcomes. Currently, no systematic review and meta-analysishas comparedthese two procedures. Methods: Our protocol was registered at PROSPERO(registration number CRD42021213763). We conducted a comprehensive electronic database search in MEDLINE, EMBASE, and CENTRAL. Two independent reviewers screened the title and abstract, followed by full-text reading and study selection based on eligibility criteria. The quality of the selected studies was analyzed with the ROBINS-I tool. Meta-analysis was carried out to compare the range of motion (functional outcome) and cosmetic outcome according to Flynn's criteria. This systematic review was conducted based on PRISMA and Cochrane handbook guidelines. Results: Our initial search yielded 163 studies, from which we included five comparative studies comprising 231 children in the qualitative and quantitative analysis. The lateral approach was more likely to result in excellent (OR 1.69, 95% CI [0.97-2.93]) and good (OR 1.12, 95% CI [0.61-2.04]) functional outcomes and less likely to result in fair (OR 0.84,95% CI [0.34-2.13]) and poor (OR 0.42, 95% CI [0.1-1.73]) functional outcomes compared to the posterior approach. In terms of cosmetic results, both approaches showed mixed findings. The lateral approach was more likely to result in excellent (OR 1.11, 95% CI [0.61-2.02]) and fair (OR 1.18, 95% CI [0.49-2.80]) but less likely to result in good (OR 0.79, 95% CI [0.40-1.55]) cosmetic outcomes. However, none of these analyseswerestatistically significant (p> 0.05). Conclusion: Lateral and posterior surgical approaches resulted in satisfactory functional and cosmetic outcomes. The two approaches are comparable for treating SHF in children when evaluated with Flynn's criteria.
Highlights
Supracondylar humeral fracture (SHF) is an elbow injury in children that most often requires surgical therapy
In the USA, it is reported that 25-40% of the incidence of SHF occurs in children's playgrounds.[2]
This study found that the lateral approach resulted in fewer poor outcomes than the posterior approach as evaluated using Flynn's criteria in the functional and cosmetic assessments
Summary
Supracondylar humeral fracture (SHF) is an elbow injury in children that most often requires surgical therapy. The literature shows that SHF is more frequent in the summer and is more common in the left elbow or non-dominant limb.[3] In addition, SHF may give rise to an emergency, namely compartment syndrome. This life and limb-threatening complication occurs in 0.3-1% of all SHF cases. A study conducted by Houshian et al shows that elbow fracture incident is 308/100,000 per year; supracondylar humeral fracture comprises 58% of all incidents.[4,5]. The lateral approach was more likely to result in excellent
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