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. 2022 Jun 9;6(6):CD013609.
doi: 10.1002/14651858.CD013609.pub2.

Interventions for treating supracondylar elbow fractures in children

Ben A Marson  1 , Adeel Ikram  1 , Simon Craxford  1 , Sharon R Lewis  2 , Kathryn R Price  3 , Benjamin J Ollivere  1
Affiliations

Interventions for treating supracondylar elbow fractures in children

Ben A Marson et al. Cochrane Database Syst Rev. .

Abstract

Background: Elbow supracondylar fractures are common, with treatment decisions based on fracture displacement. However, there remains controversy regarding the best treatments for this injury.

Objectives: To assess the effects (benefits and harms) of interventions for treating supracondylar elbow fractures in children.

Search methods: We searched CENTRAL, MEDLINE, and Embase in March 2021. We also searched trial registers and reference lists. We applied no language or publication restrictions.

Selection criteria: We included randomised and quasi-randomised controlled trials comparing different interventions for the treatment of supracondylar elbow fractures in children. We included studies investigating surgical interventions (different fixation techniques and different reduction techniques), surgical versus non-surgical treatment, traction types, methods of non-surgical intervention, and timing and location of treatment.

Data collection and analysis: We used standard methodological procedures expected by Cochrane. We collected data and conducted GRADE assessment for five critical outcomes: functional outcomes, treatment failure (requiring re-intervention), nerve injury, major complications (pin site infection in most studies), and cosmetic deformity (cubitus varus). MAIN RESULTS: We included 52 trials with 3594 children who had supracondylar elbow fractures; most were Gartland 2 and 3 fractures. The mean ages of children ranged from 4.9 to 8.4 years and the majority of participants were boys. Most studies (33) were conducted in countries in South-East Asia. We identified 12 different comparisons of interventions: retrograde lateral wires versus retrograde crossed wires; lateral crossed (Dorgan) wires versus retrograde crossed wires; retrograde lateral wires versus lateral crossed (Dorgan) wires; retrograde crossed wires versus posterior intrafocal wires; retrograde lateral wires in a parallel versus divergent configuration; retrograde crossed wires using a mini-open technique or inserted percutaneously; buried versus non-buried wires; external versus internal fixation; open versus closed reduction; surgical fixation versus non-surgical immobilisation; skeletal versus skin traction; and collar and cuff versus backslab. We report here the findings of four comparisons that represent the most substantial body of evidence for the most clinically relevant comparisons. All studies in these four comparisons had unclear risks of bias in at least one domain. We downgraded the certainty of all outcomes for serious risks of bias, for imprecision when evidence was derived from a small sample size or had a wide confidence interval (CI) that included the possibility of benefits or harms for both treatments, and when we detected the possibility of publication bias. Retrograde lateral wires versus retrograde crossed wires (29 studies, 2068 children) There was low-certainty evidence of less nerve injury with retrograde lateral wires (RR 0.65, 95% CI 0.46 to 0.90; 28 studies, 1653 children). In a post hoc subgroup analysis, we noted a greater difference in the number of children with nerve injuries when lateral wires were compared to crossed wires inserted with a percutaneous medial wire technique (RR 0.41, 95% CI 0.20 to 0.81, favours lateral wires; 10 studies, 552 children), but little difference when an open technique was used (RR 0.91, 95% CI 0.59 to 1.40, favours lateral wires; 11 studies, 656 children). Although we noted a statistically significant difference between these subgroups from the interaction test (P = 0.05), we could not rule out the possibility that other factors could account for this difference. We found little or no difference between the interventions in major complications, which were described as pin site infections in all studies (RR 1.08, 95% CI 0.65 to 1.79; 19 studies, 1126 children; low-certainty evidence). For functional status (1 study, 35 children), treatment failure requiring re-intervention (1 study, 60 children), and cosmetic deformity (2 studies, 95 children), there was very low-certainty evidence showing no evidence of a difference between interventions. Open reduction versus closed reduction (4 studies, 295 children) Type of reduction method may make little or no difference to nerve injuries (RR 0.30, 95% CI 0.09 to 1.01, favours open reduction; 3 studies, 163 children). However, there may be fewer major complications (pin site infections) when closed reduction is used (RR 4.15, 95% CI 1.07 to 16.20; 4 studies, 253 children). The certainty of the evidence for these outcomes is low. No studies reported functional outcome, treatment failure requiring re-intervention, or cosmetic deformity. The four studies in this comparison used direct visualisation during surgery. One additional study used a joystick technique for reduction, and we did not combine data from this study in analyses. Surgical fixation using wires versus non-surgical immobilisation using a cast (3 studies, 140 children) There was very low-certainty evidence showing little or no difference between interventions for treatment failure requiring re-intervention (1 study, 60 children), nerve injury (3 studies, 140 children), major complications (3 studies, 126 children), and cosmetic deformity (2 studies, 80 children). No studies reported functional outcome. Backslab versus sling (1 study, 50 children) No nerve injuries or major complications were experienced by children in either group; this evidence is of very low certainty. Functional outcome, treatment failure, and cosmetic deformity were not reported. AUTHORS' CONCLUSIONS: We found insufficient evidence for many treatments of supracondylar fractures. Fixation of displaced supracondylar fractures with retrograde lateral wires compared with crossed wires provided the most substantial body of evidence in this review, and our findings indicate that there may be a lower risk of nerve injury with retrograde lateral wires. In future trials of treatments, we would encourage the adoption of a core outcome set, which includes patient-reported measures. Evaluation of the effectiveness of traction compared with surgical fixation would provide a valuable addition to this clinical field.

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Conflict of interest statement

Ben Marson: none known Adeel Ikram: none known Simon Craxford: none known Kathryn Price: none known Benjamin Ollivere: none known

Figures

1
1
Supracondylar elbow fractures. Left to right AO/ASIF Classification 1, 2, 3, and 4
2
2
Study flow diagram
3
3
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies
4
4
Risk of bias summary: review authors' judgements about each risk of bias item for each included study. Blank spaces indicate that we did not conduct risk of bias assessment; we did not include outcome data for these studies.
5
5
Forest plot of comparison 6: different forms of surgical intervention: retrograde crossed wires versus retrograde lateral wires, outcome 6.1 nerve injury
6
6
Funnel plot for retrograde lateral wires compared with retrograde crossed wires: Analysis 1.2 Nerve injury
1.1
1.1. Analysis
Comparison 1: Different forms of surgical intervention: retrograde lateral wires versus retrograde crossed wires, Outcome 1: Treatment failure requiring a re‐intervention
1.2
1.2. Analysis
Comparison 1: Different forms of surgical intervention: retrograde lateral wires versus retrograde crossed wires, Outcome 2: Nerve injury
1.3
1.3. Analysis
Comparison 1: Different forms of surgical intervention: retrograde lateral wires versus retrograde crossed wires, Outcome 3: Major complications (pin site infections)
1.4
1.4. Analysis
Comparison 1: Different forms of surgical intervention: retrograde lateral wires versus retrograde crossed wires, Outcome 4: Cosmetic deformity: loss of carrying angle > 10 degrees or elbow deformity
1.5
1.5. Analysis
Comparison 1: Different forms of surgical intervention: retrograde lateral wires versus retrograde crossed wires, Outcome 5: Cosmetic deformity: loss of carrying angle (degrees of loss)
1.6
1.6. Analysis
Comparison 1: Different forms of surgical intervention: retrograde lateral wires versus retrograde crossed wires, Outcome 6: Cosmetic deformity: degrees of loss of carrying angle at long‐term follow‐up
1.7
1.7. Analysis
Comparison 1: Different forms of surgical intervention: retrograde lateral wires versus retrograde crossed wires, Outcome 7: Range of motion: loss of movement
1.8
1.8. Analysis
Comparison 1: Different forms of surgical intervention: retrograde lateral wires versus retrograde crossed wires, Outcome 8: Unable to return to sport and normal activities
1.9
1.9. Analysis
Comparison 1: Different forms of surgical intervention: retrograde lateral wires versus retrograde crossed wires, Outcome 9: Return to sport and normal activities: time to return to normal activities
1.10
1.10. Analysis
Comparison 1: Different forms of surgical intervention: retrograde lateral wires versus retrograde crossed wires, Outcome 10: Radiographic deformity: loss of reduction
1.11
1.11. Analysis
Comparison 1: Different forms of surgical intervention: retrograde lateral wires versus retrograde crossed wires, Outcome 11: Radiographic deformity: loss of radiographic angle
1.12
1.12. Analysis
Comparison 1: Different forms of surgical intervention: retrograde lateral wires versus retrograde crossed wires, Outcome 12: Resource use
1.13
1.13. Analysis
Comparison 1: Different forms of surgical intervention: retrograde lateral wires versus retrograde crossed wires, Outcome 13: Nerve injury: subgrouped according to technique for insertion of medial wire
2.1
2.1. Analysis
Comparison 2: Different forms of surgical intervention: lateral crossed (Dorgan) wires versus retrograde crossed wires, Outcome 1: Nerve injury
2.2
2.2. Analysis
Comparison 2: Different forms of surgical intervention: lateral crossed (Dorgan) wires versus retrograde crossed wires, Outcome 2: Major complications
2.3
2.3. Analysis
Comparison 2: Different forms of surgical intervention: lateral crossed (Dorgan) wires versus retrograde crossed wires, Outcome 3: Cosmetic deformity: loss of carrying angle > 10 degrees
2.4
2.4. Analysis
Comparison 2: Different forms of surgical intervention: lateral crossed (Dorgan) wires versus retrograde crossed wires, Outcome 4: Cosmetic deformity: loss of carrying angle (degrees of loss)
2.5
2.5. Analysis
Comparison 2: Different forms of surgical intervention: lateral crossed (Dorgan) wires versus retrograde crossed wires, Outcome 5: Range of motion: long‐term loss of total range of motion > 10 degrees
2.6
2.6. Analysis
Comparison 2: Different forms of surgical intervention: lateral crossed (Dorgan) wires versus retrograde crossed wires, Outcome 6: Radiographic deformity: long‐term loss of radiographic angle
2.7
2.7. Analysis
Comparison 2: Different forms of surgical intervention: lateral crossed (Dorgan) wires versus retrograde crossed wires, Outcome 7: Resource use
3.1
3.1. Analysis
Comparison 3: Different forms of surgical intervention: lateral crossed (Dorgan) wires versus retrograde lateral wires, Outcome 1: Nerve injury
3.2
3.2. Analysis
Comparison 3: Different forms of surgical intervention: lateral crossed (Dorgan) wires versus retrograde lateral wires, Outcome 2: Major complications: pin site infections
3.3
3.3. Analysis
Comparison 3: Different forms of surgical intervention: lateral crossed (Dorgan) wires versus retrograde lateral wires, Outcome 3: Cosmetic deformity: long‐term loss of carrying angle > 10 degrees
3.4
3.4. Analysis
Comparison 3: Different forms of surgical intervention: lateral crossed (Dorgan) wires versus retrograde lateral wires, Outcome 4: Range of motion: long‐term loss of total range of motion > 10 degrees
3.5
3.5. Analysis
Comparison 3: Different forms of surgical intervention: lateral crossed (Dorgan) wires versus retrograde lateral wires, Outcome 5: Radiographic deformity: long‐term loss of Baumann's angle
3.6
3.6. Analysis
Comparison 3: Different forms of surgical intervention: lateral crossed (Dorgan) wires versus retrograde lateral wires, Outcome 6: Radiographic deformity: long‐term loss of humeral‐capitellar angle
4.1
4.1. Analysis
Comparison 4: Different forms of surgical intervention: posterior intrafocal wires versus retrograde crossed wires, Outcome 1: Nerve injury
4.2
4.2. Analysis
Comparison 4: Different forms of surgical intervention: posterior intrafocal wires versus retrograde crossed wires, Outcome 2: Major complications (pin site infection)
4.3
4.3. Analysis
Comparison 4: Different forms of surgical intervention: posterior intrafocal wires versus retrograde crossed wires, Outcome 3: Cosmetic deformity: loss of carrying angle > 10 degrees or elbow deformity
4.4
4.4. Analysis
Comparison 4: Different forms of surgical intervention: posterior intrafocal wires versus retrograde crossed wires, Outcome 4: Range of motion: loss of range of motion > 10 degrees at long‐term follow‐up
4.5
4.5. Analysis
Comparison 4: Different forms of surgical intervention: posterior intrafocal wires versus retrograde crossed wires, Outcome 5: Radiographic deformity: loss of reduction at long‐term follow‐up
5.1
5.1. Analysis
Comparison 5: Different forms of surgical intervention: retrograde lateral wires in a parallel versus divergent configuration, Outcome 1: Major complications
5.2
5.2. Analysis
Comparison 5: Different forms of surgical intervention: retrograde lateral wires in a parallel versus divergent configuration, Outcome 2: Range of movement: loss of movement
5.3
5.3. Analysis
Comparison 5: Different forms of surgical intervention: retrograde lateral wires in a parallel versus divergent configuration, Outcome 3: Cosmetic deformity: medium‐term loss of carrying angle
5.4
5.4. Analysis
Comparison 5: Different forms of surgical intervention: retrograde lateral wires in a parallel versus divergent configuration, Outcome 4: Range of motion: medium‐term loss of flexion and extension
5.5
5.5. Analysis
Comparison 5: Different forms of surgical intervention: retrograde lateral wires in a parallel versus divergent configuration, Outcome 5: Radiographic deformity: medium‐term loss of Baumann's angle
6.1
6.1. Analysis
Comparison 6: Different forms of surgical intervention: mini‐open crossed wires versus percutaneous crossed wires, Outcome 1: Nerve injury
6.2
6.2. Analysis
Comparison 6: Different forms of surgical intervention: mini‐open crossed wires versus percutaneous crossed wires, Outcome 2: Major complications
6.3
6.3. Analysis
Comparison 6: Different forms of surgical intervention: mini‐open crossed wires versus percutaneous crossed wires, Outcome 3: Resource use
7.1
7.1. Analysis
Comparison 7: Different forms of surgical intervention: buried versus non‐buried wires, Outcome 1: Major complications: pin site infections
8.1
8.1. Analysis
Comparison 8: Different forms of surgical intervention: open versus closed reduction of displaced fractures, Outcome 1: Nerve injury
8.2
8.2. Analysis
Comparison 8: Different forms of surgical intervention: open versus closed reduction of displaced fractures, Outcome 2: Major complications: pin site infections
8.3
8.3. Analysis
Comparison 8: Different forms of surgical intervention: open versus closed reduction of displaced fractures, Outcome 3: Cosmetic deformity: loss of carrying angle > 10 degrees or elbow deformity (medium‐ and long‐term)
8.4
8.4. Analysis
Comparison 8: Different forms of surgical intervention: open versus closed reduction of displaced fractures, Outcome 4: Cosmetic deformity: loss of carrying angle in the long term (degrees of loss)
8.5
8.5. Analysis
Comparison 8: Different forms of surgical intervention: open versus closed reduction of displaced fractures, Outcome 5: Range of movement: loss of total range of movement > 10 degrees at medium term
8.6
8.6. Analysis
Comparison 8: Different forms of surgical intervention: open versus closed reduction of displaced fractures, Outcome 6: Range of movement: loss of range of movement at long‐term follow‐up
8.7
8.7. Analysis
Comparison 8: Different forms of surgical intervention: open versus closed reduction of displaced fractures, Outcome 7: Patient satisfaction with scar appearance (higher scores indicates more satisfaction)
8.8
8.8. Analysis
Comparison 8: Different forms of surgical intervention: open versus closed reduction of displaced fractures, Outcome 8: Radiographic deformity: difference in Baumann's angle (medium and long term)
8.9
8.9. Analysis
Comparison 8: Different forms of surgical intervention: open versus closed reduction of displaced fractures, Outcome 9: Radiographic deformity: capitellum posterior to anterior humeral line at late follow‐up
8.10
8.10. Analysis
Comparison 8: Different forms of surgical intervention: open versus closed reduction of displaced fractures, Outcome 10: Resource use
9.1
9.1. Analysis
Comparison 9: Surgical versus non‐surgical treatment: surgical fixation versus non‐surgical immobilisation, Outcome 1: Treatment failure
9.2
9.2. Analysis
Comparison 9: Surgical versus non‐surgical treatment: surgical fixation versus non‐surgical immobilisation, Outcome 2: Nerve injury
9.3
9.3. Analysis
Comparison 9: Surgical versus non‐surgical treatment: surgical fixation versus non‐surgical immobilisation, Outcome 3: Major complications: pin site infections
9.4
9.4. Analysis
Comparison 9: Surgical versus non‐surgical treatment: surgical fixation versus non‐surgical immobilisation, Outcome 4: Cosmetic deformity: loss of carrying angle > 10 degrees or elbow deformity
9.5
9.5. Analysis
Comparison 9: Surgical versus non‐surgical treatment: surgical fixation versus non‐surgical immobilisation, Outcome 5: Cosmetic deformity: degrees of loss of carrying angle at long‐term follow‐up
9.6
9.6. Analysis
Comparison 9: Surgical versus non‐surgical treatment: surgical fixation versus non‐surgical immobilisation, Outcome 6: Range of movement: loss of > 10 degrees total movement at long‐term follow‐up
9.7
9.7. Analysis
Comparison 9: Surgical versus non‐surgical treatment: surgical fixation versus non‐surgical immobilisation, Outcome 7: Range of movement: degrees of loss of movement at long‐term follow‐up
10.1
10.1. Analysis
Comparison 10: Different forms of traction: skin traction versus olecranon skeletal traction, Outcome 1: Nerve injury
10.2
10.2. Analysis
Comparison 10: Different forms of traction: skin traction versus olecranon skeletal traction, Outcome 2: Major complications
10.3
10.3. Analysis
Comparison 10: Different forms of traction: skin traction versus olecranon skeletal traction, Outcome 3: Cosmetic deformity: cubitus varus
10.4
10.4. Analysis
Comparison 10: Different forms of traction: skin traction versus olecranon skeletal traction, Outcome 4: Range of movement (medium term)
10.5
10.5. Analysis
Comparison 10: Different forms of traction: skin traction versus olecranon skeletal traction, Outcome 5: Resource use (duration of traction)
11.1
11.1. Analysis
Comparison 11: Different forms of non‐surgical intervention: backslab versus sling for undisplaced fractures, Outcome 1: Parental satisfaction (unsure or unwilling to use same device again)
11.2
11.2. Analysis
Comparison 11: Different forms of non‐surgical intervention: backslab versus sling for undisplaced fractures, Outcome 2: Return to normal activities at 2 weeks
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References

References to studies included in this review

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    1. Marson BA. [personal communication]. Email to: GM Sharma 29 September 2020.
    1. Naik LG, Sharma GM, Badgire KS, Qureshi F, Waghchoure C, Jain V. Cross pinning versus lateral pinning in the management of type III supracondylar humerus fractures in children. Journal of Clinical and Diagnostic Research 2017;11(8):RC01-03. [PMID: ] - PMC - PubMed
Naveen 2017 {published data only}
    1. Naveen PR, Chaitanya PR. A prospective study of crossed versus lateral only pinning in the treatment of displaced supracondylar fractures of the humerus in children. International Journal of Orthopaedics Sciences 2017;3(3):400-4.
Oakley 2009 {published and unpublished data}
    1. ACTRN12607000047493. A randomised controlled trial of two methods of immobilising supracondylar fractures of the humerus [Is immobilisation with collar and cuff or backslab and sling associated with less pain and better parent satisfaction in children with minimally displaced supracondylar fractures of the humerus?]. www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=81800&isRev... (first received 12 January 2007).
    1. Marson BA. [personal communication]. Email to: E Oakley 13 November 2020.
    1. Oakley E, Barnett P, Babl FE. Backslab versus nonbackslab for immobilization of undisplaced supracondylar fractures: a randomized trial. Pediatric Emergency Care 2009;25(7):452-6. [PMID: ] - PubMed
Othman 2017 {published data only}
    1. Othman M, Nahla A, El-Malt A. A comparative study of three percutaneous pinning techniques for paediatric supracondylar humeral fractures. ARC Journal of Othopedics 2017;2(2):11-9.
Palange 2019 {published data only}
    1. Palange ND, Prasannakumar GS, Mane A, Pawar E. A comparison between percutaneous cross k wire and lateral k wires fixation in management of Type III Gartland paediatric supracondylar fractures. International Journal of Orthopaedics Sciences 2019;5(2):119-22.
Pandey 2008 {published data only}
    1. Pandey S, Shrestha D, Gorg M, Singh GK, Singh MP. Treatment of supracondylar fracture of the humerus (type IIB and III) in children: a prospective randomized controlled trial comparing two methods. Kathmandu University Medical Journal 2008;6(23):310-8. - PubMed
Patil 2017 {published data only}
    1. Patil SP, Gaonkar N, Pandey P, Kumar S, Shah R, Garud A, et al. A comparative study of two percutaneous pinning techniques (Cross K wire vs Lateral K wire) for Gartland type III pediatric supracondylar fracture of the humerus. International Journal of Orthopaedics Sciences 2017;3(4):665-8.
Pavone 2016 {published data only}
    1. Pavone V, Riccioli M, Testa G, Lucenti L, De Cristo C, Condorelli G, et al. Surgical treatment of displaced supracondylar pediatric humerus fractures: comparison of two pinning techniques. Journal of Functional Morphology and Kinesiology 2016;1(1):39-47.
Prashant 2016 {published data only}
    1. Prashant K, Lakhotia D, Bhattacharyya TD, Mahanta AK, Ravoof A. A comparative study of two percutaneous pinning techniques (lateral vs medial-lateral) for Gartland type III pediatric supracondylar fracture of the humerus. Journal of Orthopaedics and Traumatology 2016;17(3):223-9. [PMID: ] - PMC - PubMed
Raj 2018 {unpublished data only}
    1. Raj KN. Comparision of Functional Outcome Between Traditional and Lateral Crossed Pinning in Supra condylar Humerus Fractures of Children [Masters thesis]. Chennai: Madras Medical College, 2018.
Rakha 2020 {published data only}
    1. Rahka A, Khan RD, Arshad A, Khan ZAli, Ahmad S, Mahmood S. Comparison of efficacy between open and close reduction in supracondylar fracture of humerus in children using Flynn’s criteria. Annals of Punjab Medical College (APMC) 2020;14(1):32-6.
Ray 2019 {published data only}
    1. Ray B, Waikhom S. A comparative study of closed reduction and percutaneous crossed pinning vs open reduction and crossed pinning in Gartland Type III supracondylar fracture of humerus in children. International Journal of Scientific Research 2019;8(3):15-9.
Rizk 2019 {published data only}
    1. Rizk AS, Kandil MI. Conventional versus lateral cross-pinning (Dorgan’s technique) for fixation of displaced pediatric supracondylar humeral fractures: a randomized comparative study. Egyptian Orthopaedic Journal 2019;53:348-58.
Sadek 2018 {published data only}
    1. Sadek AA, Ibrahim MI, Elazab HE, Abdel Rahman HH. Comparison of fixation of supracondylar humeral fractures in children by lateral cross-wiring technique versus traditional lateral pinning. Sohag Medical Journal 2018;22(1):265-71.
Saeed 2020 {published data only}
    1. Saeed UB, Waseem M, Hassan AR, Khan ZA, Gill D, Ahmad S. Supracondylar fracture, buried vs non buried K wires. Professional Medical Journal 2020;27(03):467-71.
Said 2015 {unpublished data only}
    1. Said EA. Crossed-pin configuration versus lateral pins in treatment of supracondylar humeral fracture in children. In: 36th Société Internationale de Chirurgie Orthopédique et de Traumatologie'(SICOT) Orthopaedic World Congress; 2015 Sep 17-19; Guangzhou (China). 2015.
Sankar 2019 {published data only}
    1. Sankar S, D’Souza JJ, Debuka E, Vyas T, Jagani N. The functional outcome of displaced supracondylar fracture humerus in children treated by open reduction and internal fixation by lateral pins compared to medial and lateral pins: a prospective study. National Journal of Clinical Orthopaedics 2019;3(2):78-84.
Shafi‐Ur‐Rehman 2013 {published data only}
    1. Shafi-Ur-Rehman, Hayat K, Bajwa A, Yousaf M, Rehman A, Shafaq SA. To compare the outcome of patients with supracondylar fractures of humerus treated by cross K-wires and lateral entry K-wires in children. Pakistan Journal of Medical and Health Sciences 2013;7(2):500-5.
    1. Shah ZA, Arif U. Displaced supracondylar humeral fractures; treatment among children: crossed versus lateral pinning. Professional Medical Journal 2013;20(5):818-24.
Shah 2017 {published data only}
    1. Shah SA, Asimuddin M. Management of supracondylar fractures of the humerus in children: conservative versus operative. International Journal of Orthopaedics 2017;3(1):14-20.
    1. Shah SA, Asimuddin M. Management of supracondylar fractures of the humerus in children: conservative versus operative. Scholars Journal of Applied Medical Sciences 2016;4(6B):1960-9.
Shamma 2020 {published data only}
    1. Shamma AE, Moawad Abd El-Motalb M, Abd El-Hamed ME, Tash E. Lateral divergent pinning versus lateral parallel pinning in management of supracondylar fractures of the humerus in children. Al-Azhar Medical Journal 2020;49(2):513-24.
Subash 2020 {published data only}
    1. Subash Y, Natarajan S, Lydia M. A study comparing two different pinning techniques in supracondylar fractures of the humerus. International Journal of Research in Pharmaceutical Sciences 2020;11(Special Issue 2):48-53.
Tripuraneni 2009 {published data only}
    1. Tripuraneni KR, Bosch PP, Schwend RM, Yaste JJ. Prospective, surgeon-randomized evaluation of crossed pins versus lateral pins for unstable supracondylar humerus fractures in children. Journal of Pediatric Orthopaedics. Part B 2009;18(2):93-8. [PMID: ] - PubMed
Vaidya 2009 {published data only}
    1. Vaidya SM. Percutaneous fixation of displaced supracondylar fracture in children comparing lateral with medial and lateral pin [Masters thesis]. Mahé, Seychelles: University of Seychelles, 2009.
Zhu 2016 {published data only}
    1. Zhu YL, Hu W, Yu XB, Wu YS, Sun LJ. A comparative study of two closed reduction methods for pediatric supracondylar humeral fractures. Journal of Orthopaedic Science 2016;21(5):609-13. [PMID: ] - PubMed

References to studies excluded from this review

AboHasan 2020 {published data only}
    1. AboHasan MA, Idrees K, Fahmy MH. Closed reduction and lateral percutaneous pin fixation for displaced supracondylar humerus fractures in children. Zagazig University Medical Journal 2020;26(2):233-8.
Aktekin 2008 {published data only}
    1. Aktekin CN, Toprak A, Ozturk AM, Altay M, Ozkurt B, Tabak AY. Open reduction via posterior triceps sparing approach in comparison with closed treatment of posteromedial displaced Gartland type III supracondylar humerus fractures. Journal of Pediatric Orthopaedics. Part B 2008;17(4):171-8. - PubMed
Arif 2014 {published data only}
    1. Arif M, Azeem M, Khurshid J. Surgical outcome of medial and lateral approach in treatment of paediatriac humeral supracondylar fracture. Journal of Sheikh Zayed Medical College 2014;5(3):644-7.
Arif 2017 {published data only}
    1. Arif M, Akram R, Zaman AU, Ahmad I, Aziz A. Outcome of lateral approach for displaced supracondylar humerus fractures in children. Pakistan Journal of Medical and Health Sciences 2017;11(3):825-8.
Ariyawatkul 2016 {published data only}
    1. Ariyawatkul T, Eamsobhana P, Kaewpornsawan K. The necessity of fixation in Gartland type 2 supracondylar fracture of the distal humerus in children (modified Gartland type 2A and 2B). Journal of Pediatric Orthopaedics. Part B 2016;25(2):159-64. - PubMed
Arnala 1991 {published data only}
    1. Arnala I, Paananen H, Lindell-Iwan L. Supracondylar fractures of the humerus in children. European Journal of Pediatric Surgery 1991;1(1):27-9. - PubMed
Balanescu 2013 {published data only}
    1. Balanescu R, Ulici A, Rosca D, Topor L, Barbu M. Neurovascular abnormalities in Gartland III supracondylar fractures in children. Chirurgia (Bucuresti) 2013;108(2):241-4. - PubMed
Bales 2010 {published data only}
    1. Bales JG, Spencer HT, Wong MA, Fong YJ, Zionts LE, Silva M. The effects of surgical delay on the outcome of pediatric supracondylar humeral fractures. Journal of Pediatric Orthopedics 2010;30(8):785-91. - PubMed
Bulbul 2011 {published data only}
    1. Bulbul M, Ayanoglu S, Imren Y, Kahraman S, Esenyel CZ, Gurbuz H. Does two parallel lateral-only pin configuration provide stable osteosynthesis for pediatric supracondylar humerus fractures? Nobel Medicus 2011;7(3):36-40.
Chen 2001 {published data only}
    1. Chen RS, Liu XS, Lin XM, Feng M, Zhu JM, Ye FQ. Supracondylar extension fracture of the humerus in children. Journal of Bone and Joint Surgery. British Volume 2001;83-B(6):883-7. - PubMed
Diri 2003 {published data only}
    1. Diri B, Tomak Y, Karaismailoglu TN. The treatment of displaced supracondylar fractures of the humerus in children (an evaluation of three different treatment methods). Turkish Journal of Trauma & Emergency Surgery 2003;9(1):62-9. - PubMed
Ducic 2016b {published data only}
    1. Ducic S, Bumbasirevic M, Radlovic V, Nikic P, Bukumiric Z, Brdar R, et al. Displaced supracondylar humeral fractures in children: comparison of three treatment approaches. Srpski Arhiv Za Celokupno Lekarstvo 2016;144(1-2):46-51. - PubMed
El‐Ngehy 2018 {published data only}
    1. El-Ngehy Alaa AM, Eladawy Amr M, El-Sharkawi Walid F, Naeem Muhammed MG. Crossed pinning versus two lateral wires in the management of displaced supracondylar humerus fractures in children. Zagazig University Medical Journal 2018;24(6):467-72.
Ensafdaran 2005 {published data only}
    1. Ensafdaran A, Emami MJ, Borghei M. A comparative study of lateral approach versus posterior approach for the surgical treatment of supracondylar fractures of the humerus in children. Medical Journal of The Islamic Republic of Iran (MJIRI) 2005;19(3):213-7.
Eren 2005 {published data only}
    1. Eren A, Ozkut AT, Altintas F, Guven M. Comparison between the lateral and medial approaches in terms of functional and cosmetic results in the surgical treatment of type III supracondylar humeral fractures in children. Acta Orthopaedica et Traumatologica Turcica 2005;39(3):199-204. - PubMed
Fahmy 2009 {published data only}
    1. Fahmy MA, Hatata MZ, Al-Seesi H. Posterior intrafocal pinning for extension-type supracondylar fractures of the humerus in children. Journal of Bone and Joint Surgery - Series B 2009;91(9):1232-6. - PubMed
Hegazy 2020 {published data only}
    1. Hegazy MO, Meselhy MA, EL-Nabasy AA. Lateral divergent pinning versus lateral parallel pinning in management of supracondylar fractures of the humerus in children. Benha Journal of Applied Sciences 2020;5(6 (part 2)):1-6.
Keskin 2014 {published data only}
    1. Keskin D, Sen H. The comparative evaluation of treatment outcomes in pediatric displaced supracondylar humerus fractures managed with either open or closed reduction and percutaneous pinning. Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca 2014;81(6):380-6. - PubMed
Khan 2007 {published data only}
    1. Khan AQ, Goel S, Abbas M, Sherwani MK. Percutaneous K-wiring for Gartland type III supracondylar humerus fractures in children. Saudi Medical Journal 2007;28(4):603-6. - PubMed
Lee 2008 {published data only}
    1. Lee YH, Lee SK, Kim BS, Chung MS, Baek GH, Gong HS, et al. Three lateral divergent or parallel pin fixations for the treatment of displaced supracondylar humerus fractures in children. Journal of Pediatric Orthopaedics 2008;28(4):417-22. - PubMed
Li 2013 {published data only}
    1. Li WQ, Guo YM, He J, Lu S. Dynamic external fixation for stabilizing Baumman angle during midanaphase in supracondylar fracture of humerus in children. China Journal of Orthopaedics and Traumatology 2013;26(8):656-8. - PubMed
Li 2017 {published data only}
    1. Li J, Fu D, Yu C, Wang S, Ze R, Tang X. Surgical management of delayed irreducible Gartland III supracondylar fractures in children: open reduction and internal fixation versus external fixation. Journal of Shoulder and Elbow Surgery 2017;26(2):299-304. - PubMed
Marashi 2013 {published data only}
    1. Marashi Nejad SA, Mehdi Nasab S, Baianfar M. Effect of supination versus pronation in the non-operative treatment of pediatric supracondylar humerus fractures. Archives of Trauma Research 2013;2(1):26-9. - PMC - PubMed
NCT00904137 {published data only}
    1. NCT00904137. Treatment of type I supracondylar fractures of the humerus. clinicaltrials.gov/ct2/show/NCT00904137 (first received 19 May 2009).
Pescatori 2012 {published data only}
    1. Pescatori E, Memeo A, Brivio A, Trapletti A, Camurri S, Pedretti L, et al. Supracondylar humerus fractures in children: a comparison of experiences. Journal of Pediatric Orthopaedics. Part B 2012;21(6):505-13. - PubMed
Rawoot 2014 {unpublished data only}
    1. Rawoot A, du Toit J, Ikram A. The treatment of Gartland 2 and 3 supracondylar humerus fractures in children in either a prone or supine position: practical implications for future treatment. British Editorial Society of Bone & Joint Surgery 2014;96:11.
Roy 2019 {published data only}
    1. Roy MK, Alam MT, Rahman MW, Islam MS, Sayeed KA, Kamal MZ, et al. Comparative study of stabilization of humerus supracondylar fracture in children by percutaneous pinning from lateral side and both sides. Mymensingh Medical Journal: MMJ 2019;28(1):15-22. - PubMed
Sadik 2015 {published data only}
    1. Sadik Diaa G. Medial and lateral percutaneous fixation versus lateral fixation for treatment of Gartland type ii, iii supracondylar fracture of humerus in children. Iraqi Journal of Medical Sciences 2015;13(2):183-90.
Shah 2013 {published data only}
    1. Shah ZA, Arif U. Displaced supracondylar humeral fractures; treatment among children: crossed versus lateral pinning. Professional Medical Journal 2013;20(5):818-24.
Shoaib 2003 {published data only}
    1. Shoaib M, Hussain A, Kamran H, Ali J. Outcome of closed reduction and casting in displaced supracondylar fracture of humerus in children. Journal of Ayub Medical College, Abbottabad : JAMC 2003;15(4):23-5. - PubMed
Siddiq 2020 {published data only}
    1. Siddiq K, ullah Mehmood A, Hameed MH, Chishti MK, Ali MN, Hussain N. Comparison of outcome with medial versus lateral approach for operative fixation of superacondylar humeral fractures in paediatric patients. Professional Medical Journal 2020;27(10):2045-9.
Silva 2018 {published data only}
    1. Silva M, Sadlik G, Avoian T, Ebramzadeh E. A removable long-arm soft cast to treat nondisplaced pediatric elbow fractures: a randomized, controlled trial. Journal of Pediatric Orthopaedics 2018;38(4):223-9. - PubMed
Sutton 1992 {published data only}
    1. Sutton WR, Greene WB, Georgopoulos G, Dameron TB Jr. Displaced supracondylar humeral fractures in children. A comparison of results and costs in patients treated by skeletal traction versus percutaneous pinning. Clinical Orthopaedics & Related Research 1992;278:81-7. - PubMed
Venkatadass 2015 {published data only}
    1. Venkatadass K, Balachandar G, Rajasekaran S. Is prone position Ideal for manipulation and pinning of displaced pediatric extension-type supracondylar fractures of humerus? A randomized control trial. Journal of Pediatric Orthopedics 2015;35(7):672-6. - PubMed
Young 2012 {published data only}
    1. Young S, Fevang JM, Gullaksen G, Nilsen PT, Engesaeter LB. Parent and patient satisfaction after treatment for supracondylar humerus fractures in 139 children: no difference between skeletal traction and crossed pin fixation at long-term followup. Advances in Orthopaedics 2012;2012:[6 p.]. - PMC - PubMed

References to studies awaiting assessment

Afridi 2002 {published data only}
    1. Afridi HD, Ansar AH. Prospective randomised study of the management of supracondylar (humerus) fractures in children. Medical Channel Journal 2002;8(1):41-3.
Andreasi 1985 {published data only}
    1. Andreasi A. Comparison of two methods of percutaneous osteosynthesis with Kirschner wires in diastatic supracondylar fractures of the humerus in children. Minerva Ortopedica 1985;36(5):295-300.
Bing 2017 {published data only}
    1. Bing C, Zhenglin L, Yanjun G. Clinical observation of early closed reduction and flexible lateral Kirschner wire external fixation for supracondylar fracture of humerus in children. Journal of Mathematical Medicine 2017;30:1288–90.
Boparai 2006 {published data only}
    1. Boparai RS, Diwan D. Supracondylar fractures in children - closed reduction vs open reduction. Indian Journal of Orthopaedics 2006;40(2):103-7.
Botchu 2006 {published data only}
    1. Botchu R, Shetty S, Shetty V, Shetty AC. Displaced supracondylar fractures of humerus in children - to pin or not to? European Journal of Trauma 2006;32(Suppl 1):162.
Evans 1998 {published data only}
    1. Evans SC, Hamilton P, Godette G, Torode IP, Dickens DR, Broughton NS, et al. Supracondylar fractures of the humerus in children: a randomised clinical trial [abstract]. Journal of Bone and Joint Surgery: British Volume 1998;80(Suppl 2):140-1.
He 2009 {published data only}
    1. He BX, Zhang B, Tan YJ. Comparison of clinical effects of various external fixation for the treatment of humeral supracondylar fracture. China Journal of Orthopaedics and Traumatology 2009;22(3):190-2. - PubMed
Lu 2011 {published data only}
    1. Lu X, Luo B, Li K. Different methods for treatment of patients with supracondylar fractures of the humerus: a randomized study. China Modern Medicine 2011;18:74–5.
NCT04582123 {published data only}
    1. NCT04582123. Comparison of cross pin configurations in supracondylar humerus fracture treatment: 2 pins versus 3 pins. clinicaltrials.gov/show/NCT04582123 (first received 9 October 2020).
Sapkota 2019 {published data only}
    1. Sapkota K, Wahegaonkar K, Ranjeet N, Thapa U, Onta P. Comparison of cross pinning versus lateral three pins in type three supracondylar fracture of distal humerus in children. Asian Journal of Medical Sciences 2019;10:58-61.

References to ongoing studies

ACTRN12612000480886 {published data only}
    1. ACTRN12612000480886. Study of treatment methods for undisplaced supracondylar humeral (elbow) fractures in children [The effect of three different types of external immobilisation methods comparing pain during application and functional outcome for children with undisplaced supracondylar humeral fractures]. www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=362446&isRe... (first received 2 June 2012).
CTRI/2020/06/025504 {published data only}
    1. CTRI/2020/06/025504. Comparison of short term functional and radiological outcomes between two versus three lateral pin fixation techniques in fractures of lower part on arm bone in children [Comparison of short term functional and radiological outcomes between two versus three lateral pinning techniques in Gartland type III supracondylar humerus fractures in children - a randomized control trial]. www.who.int/trialsearch/Trial2.aspx?TrialID=CTRI/2020/06/025504 (first received 1 June 2020).
PACTR201702001960109 {published data only}
    1. PACTR201702001960109. Treatment of supracondylar humerus fractures in children [Comparison between crossing wires versus two lateral wires in the management of displaced supracondylar humerus in children]. trialsearch.who.int/?TrialID=PACTR201702001960109 (first received 3 January 2017).

Additional references

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References to other published versions of this review

Marson 2020b
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