Risk Factors for Loss of Fixation in Pediatric Supracondylar Humeral Fractures
Thananit Sangkomkamhang MD*, Udomsin Singjam MD*, Duangjai Leeprakobboon MD*
Affiliation : * Department of Orthopedic Surgery, Khon Kaen Regional Hospital and Academic Center, Khon Kaen, Thailand
Objective : The aim of this study was to determine the risk factors for loss of fixation in pediatric supracondylar humeral
fractures.
Material and Method: The data were analyzed regarding assessed loss of fixation in 256 supracondylar fractures from
January 2010 to December 2012, all of which were treated by closed or open reduction and Kirschner wire fixation. The
confounding factors that were thought to cause loss of reduction were collected. Multivariate logistic regression analysis was
performed to predict risk factors.
Results : Reduction was lost in 14.8% of the patients. Poor surgical technique was significantly higher in the cases with lost
reduction (odds ratio: 15.21). Additionally, cases with only lateral pins placement (odds ratio: 2.57), Gartland type 3
fractures (odds ratio: 2.38), and, obesity with a BMI >25 (odds ratio: 14.35) had a significantly higher risk of losing
reduction and fixation. Other factors including age, energy type of injury, time of surgery, and time to surgery were not
associated with risk.
Conclusion : The loss of reduction following fracture fixation is associated with poor surgical technique, fixation with lateral
pinning only, Gartland type 3 fractures, and pediatric obesity (BMI >25). The stability of fracture fixation in pediatric
supracondylar fractures is largely dependent on the use of effective fixation techniques. Cross pinning provides a more stabile
fixation than lateral pinning.
Keywords : Supracondylar fracture, Humerus, Risk factor, Failure, Fixation
