Does Emergency Department Closed Reduction Reduce the Need for Surgery in Children Under Four with Supracondylar Humerus Fractures? A Retrospective Study
Süleyman Kozlu1, Recep Kurnaz21Department of Orthopaedics and Traumatology, Faculty of Medicine, Kutahya Health Sciences University, Kutahya, Türkiye, 2Department of Orthopaedics and Traumatology, Acıbadem Eskisehir Hospital, Eskisehir, Türkiye Department of Orthopaedics and Traumatology, Acıbadem Eskisehir Hospital, Eskisehir, Türkiye
Objectives: To determine whether emergency department closed reduction reduces the need for surgical intervention in children under four years of age with supracondylar humerus fractures. Methods: This retrospective study included children aged 0–4 years treated for supracondylar humerus fractures between January 2019 and December 2024. Demographic characteristics, Gartland classification, performance and quality of closed reduction, loss of reduction during follow-up, and surgical intervention were recorded. Reduction quality was categorized as anatomic, acceptable, or unacceptable based on predefined radiographic criteria. Multivariable logistic regression analysis was performed to identify independent predictors of surgical intervention. Results: Thirty-four patients (mean age 2.8±1.1 years) were included. Closed reduction was performed in 15 patients (44.1%) without sedation. Anatomic or acceptable reduction was achieved only in Gartland Type I–II fractures, whereas unacceptable reduction occurred exclusively in Type III fractures. Overall, 16 patients (47.1%) required surgery. Surgical rates increased with poorer reduction quality and higher Gartland classification. Gartland classification and reduction quality were identified as independent predictors of surgical intervention. Conclusion: Emergency department closed reduction without sedation may reduce the need for surgery in selected children under four years of age, particularly in Gartland Type I and II supracondylar humerus fractures. Keywords: Closed reduction, Gartland classification, Pediatric elbow fracture, Supracondylar humerus fracture
Cite This Article
Kozlu S, Kurnaz R. Does Emergency Department Closed Reduction Reduce the Need for Surgery in Children Under Four with Supracondylar Humerus Fractures? A Retrospective Study. EJMI. 2025; 9(4): 262-268
Corresponding Author: Süleyman Kozlu