Does the fracture line position relative to the olecranon fossa affect surgical difficulty and outcomes in pediatric supracondylar humerus fractures? Pediatrik suprakondiler humerus kırıklarında kırık hattının olekranon fossaya göre pozisyonu cerrahi zorluğu ve sonuçları etkiler mi?

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EGELİ E., Turgut A.

Ulusal Travma ve Acil Cerrahi Dergisi, cilt.32, sa.1, ss.63-70, 2026 (SCI-Expanded, Scopus, TRDizin) identifier identifier

  • Yayın Türü: Makale / Tam Makale
  • Cilt numarası: 32 Sayı: 1
  • Basım Tarihi: 2026
  • Doi Numarası: 10.14744/tjtes.2025.75009
  • Dergi Adı: Ulusal Travma ve Acil Cerrahi Dergisi
  • Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, CINAHL, EMBASE, MEDLINE, TR DİZİN (ULAKBİM)
  • Sayfa Sayıları: ss.63-70
  • Anahtar Kelimeler: elbow fracture, Humerus fracture, pediatric supracondylar humerus fracture
  • Uşak Üniversitesi Adresli: Evet

Özet

BACKGROUND: This study aimed to investigate whether the level of the fracture line relative to the olecranon fossa influences surgical difficulty, complication rates, and radiological outcomes in pediatric supracondylar humerus fractures (PHSF). METHODS: A retrospective review was conducted of 822 children who underwent surgical treatment for PHSF. Patients were categorized according to the location of the fracture line relative to the apex of the olecranon fossa: high-level (proximal to the fossa, n=163) and low-level (at or distal to the fossa, n=659). High-level fractures were further classified as oblique (n=40) or transverse (n=123), based on the angle between the fracture line and the transepicondylar line. Patient demographics, fracture characteristics, surgical parameters, complications, radiographic findings, and revision rates were analyzed. RESULTS: There were no significant differences between groups in terms of patient demographics, fracture side, open versus closed fracture status, neurovascular injury, or associated trauma (p>0.1). High-level fractures were significantly more unstable, required longer surgical durations, and showed a greater number of K-wire cortical scars compared to low-level fractures (p<0.05). K-wire configuration, number, and diameter showed no significant differences. Subgroup analysis demonstrated that oblique high-level fractures more often required divergent pin configurations and had significantly higher revision rates compared with transverse high-level fractures (p=0.049 and p=0.004, respectively). CONCLUSION: Fractures located proximal to the olecranon fossa are more unstable and technically demanding, resulting in longer operation times and more intraoperative pinning attempts. Among high-level fractures, oblique types are especially prone to technical challenges and increased revision rates, highlighting the importance of fracture morphology in surgical planning.