O3263: Examining Outcomes for Operative versus Non-Operative Treatment of Pediatric Type II Supracondylar Humerus Fractures: A Systematic Review of Comparative Studies

Background: The optimal management of type II supracondylar humerus fractures (SCHF) is unclear. We performed a PRISMA-inspired systematic review is to synthesize the literature regarding outcomes and complications associated with non-operative versus operative management for pediatric type II SCHF to guide decision-making and structure further research efforts.

Methods: We searched PubMed, Web of Science, MEDLINE, and CINAHL from database inception until February 7th, 2024, and study was registered on Open Science Framework. Inclusion criteria were articles that examined pediatric patients ( < 18 years old), examined type II SCHF (any type of type II SCHF), had English full-text, and compared operative versus non-operative care. Article quality was assessed by the Methodological Index for Non-Randomized Studies (MINORS) scale. A narrative approach was utilized due to study heterogeneity.

Results: Our search returned 417 candidate studies, from which seven comparative studies met inclusion criteria. All articles were of moderate quality per MINORS criteria. Patients (n=1,446; mean age 4.9 ± 0.2 years; mean follow-up time 5.0 ± 0.5 months) received either operative care (n=427) or non-operative care (n=1,019) for type II SCHF. Numerous studies revealed similar values for carrying angle, Baumann’s angle, elbow range-of-motion, and patient reported function/satisfaction between treatment groups. Patients had low rates of avascular necrosis and loss of reduction regardless of treatment, 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). Non-operative treatment failure requiring operative treatment occurred in 8.9-20.6% of patients who received non-operative care. Factors associated with operative care were rotational deformity, varus/valgus malalignment, and shaft-condylar angle < 30°.

Conclusion: 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. Clinicians should be aware of a relatively high rate of non-operative care failure (up to 20.6%). Further studies should seek to identify anatomic specific parameters that identify those at risk of poor functional outcomes or higher risk of failing attempted non-operative management.