Risk factors associated with failed closed reduction and per-cutaneous pinning in supracondylar fractures of humerus in children.

Abstract

Objective: To determine the factors associated with failed closed reduction in supra condylar fractures of humerus in children. Study Design: Descriptive Cross-sectional study. Setting: Department of Orthopaedic, Lady Reading Hospital, Peshawar. Period: March 2025 to August 2025. Methods: Ninety-three children aged 2–12 years with supracondylar humerus fractures were enrolled using consecutive sampling. Demographic data, injury mechanism, clinical findings, and radiographic classification were documented. Failure of closed reduction was defined as inability to obtain and maintain satisfactory alignment under fluoroscopy after manipulation and pin fixation. Data were stratified and associations were assessed using the chi-square test, with a p-value of ≤0.05 considered statistically significant. Results: Mean age was 7.1±3.3 years; 73 (78.5%) were male. Right-sided injuries 58 (62.4%) and low-energy mechanisms 73 (78.5%) were most common. Delayed presentation occurred in 63 (67.7%), marked swelling in 19 (20.4%), and Gartland type III fractures in 10 (10.8%). Younger children (≤8 years) were significantly more likely to show swelling (p=0.019), while left-sided injuries had higher rates of delay (p=0.015). Conclusion: Delayed presentation, massive swelling, and severe fracture type were strongly associated with failure of closed reduction and percutaneous pinning, underscoring the importance of early evaluation and timely surgical management.