Supracondylar Humerus Fracture Treatment in Children: A Comparison Between Supine and Prone Positions
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Published:
Feb 24, 2025
Keywords:
Distal humeral fractures, supracondylar distal humerus fracture, prone position, supine position
Main Article Content
Abstract
Introduction: Supracondylar humeral fractures are common injuries in pediatric patients, accounting for approximately 60-70% of all elbow fractures in this population. The aim of this study was to describe the clinical and radiological outcomes of osteodesis for supracondylar humeral fractures in pediatric patients and to evaluate the impact of patient positioning (prone vs. supine).
Materials and Methods: A retrospective study was conducted, including all patients under 16 years of age with Grade II and III Gartland supracondylar humeral fractures who underwent humerus reduction and osteodesis between 2002 and 2022, with a minimum follow-up of 6 months.
Results: The study included 265 patients, of whom 127 underwent surgery in the supine position and 138 in the prone position. The most significant finding of our study was that osteodesis achieves excellent clinical and radiological outcomes, and the patient’s position does not have a significant impact on the surgery.
Conclusions: Reduction and osteodesis of the humerus provide excellent clinical and radiological outcomes for the treatment of supracondylar fractures. The patient’s position (prone or supine) does not appear to affect the consolidation rate or limb function.
Materials and Methods: A retrospective study was conducted, including all patients under 16 years of age with Grade II and III Gartland supracondylar humeral fractures who underwent humerus reduction and osteodesis between 2002 and 2022, with a minimum follow-up of 6 months.
Results: The study included 265 patients, of whom 127 underwent surgery in the supine position and 138 in the prone position. The most significant finding of our study was that osteodesis achieves excellent clinical and radiological outcomes, and the patient’s position does not have a significant impact on the surgery.
Conclusions: Reduction and osteodesis of the humerus provide excellent clinical and radiological outcomes for the treatment of supracondylar fractures. The patient’s position (prone or supine) does not appear to affect the consolidation rate or limb function.
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How to Cite
Cucalón, G. R., García Osso, L., Iglesias, S. L., Levy, E. J., & Dal Lago, J. E. (2025). Supracondylar Humerus Fracture Treatment in Children: A Comparison Between Supine and Prone Positions. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 90(1), 43-50. https://doi.org/10.15417/issn.1852-7434.2025.90.1.1818
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Clinical Research
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References
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1121-32. https://doi.org/10.2106/JBJS.G.01354
2. Ogden JA. The humerus. En: Ogden JA. Skeletal injury in the child. 3rd ed. New York: Springer-Verlag; 2000.
3. Farnsworth C, Silva P, Mubarak S. Etiology of supracondylar humerus fractures. J Pediatr Orthop 1998;18(1):38-
42. PMID: 9449099
4. Charnley J. Closed treatment of common fractures. 3rd ed. Edinburgh: Churchill Livingstone; 1961, p. 105-15.
5. Minkowitz B, Busch MT. Supracondylar humerus fracture. Current trends and controversies. Orthop Clin North Am 1994;25(4):581-94. PMID: 8090472
6. John SD, Wherry K, Swischuk LE, Phillips WA. Improving detection of pediatric elbow fractures by understanding their mechanics. Radiographics 1996;16(6):1443-60. https://doi.org/10.1148/radiographics.16.6.8946546
7. Mangwani J, Nadarajah R, Paterson JM. Supracondylar humeral fractures in children: ten years’ experience in a
teaching hospital. J Bone Joint Surg Br 2006;88(3):362-5. https://doi.org/10.1302/0301-620X.88B3.16425
8. Joshi T, Koder A, Herman MJ. Staying out of trouble: complications of supracondylar humerus fractures. Instr
Course Lect 2019;68:357-66. PMID: 32032077
9. Kropelnicki A, Ali AM, Popat R, Sarraf KM. Paediatric supracondylar humerus fractures. Br J Hosp Med (Lond)
2019;80(6):312-6. https://doi.org/10.12968/hmed.2019.80.6.312
10. Gartland JJ. Management of supracondylar fractures of the humerus in children. Surg Gynecol Obstet 1959;109(2):145-54. PMID: 13675986
11. De Pellegrin M, Fracassetti D, Moharamzadeh D, Origo C, Catena N. Advantages and disadvantages of the prone position in the surgical treatment of supracondylar humerus fractures in children. A literature review. Injury 2018;49(Suppl 3):S37-S42. https://doi.org/10.1016/j.injury.2018.09.046
12. Guler O, Mutlu S, Isyar M, Mutlu H, Cerci H, Mahirogullari M. Prone versus supine position during surgery for
supracondylar humeral fractures. J Orthop Surg (Hong Kong) 2016;24(2):167-9. https://doi.org/10.1177/1602400209
13. Pavone V, Vescio A, Riccioli M, Culmone A, Cosentino P, Caponnetto M, et al. Is supine position superior to
prone position in the surgical pinning of supracondylar humerus fracture in children? J Funct Morphol Kinesiol
2020;5(3):57. https://doi.org/10.3390/jfmk5030057
14. Sapienza M, Testa G, Vescio A, Panvini FMC, Caldaci A, Parisi SC, et al. The role of patient position in the surgical treatment of supracondylar fractures of the humerus: comparison of prone and supine position. Medicina (Kaunas) 2023;59(2):374. https://doi.org/10.3390/medicina59020374
15. Alton TB, Werner SE, Gee AO. Classifications in brief: the Gartland classification of supracondylar humerus
fractures. Clin Orthop Relat Res 2015;473(2):738-41. https://doi.org/10.1007/s11999-014-4033-8
16. Generoso TO, Pacífico Junior GM, Barcelos FM, Blumetti FC, Braga SR, Ramalho Junior A. The Baumann angle:
An analysis from theory to practice. Rev Bras Ortop (Sao Paulo) 2022;57(6):1039-44. https://doi.org/10.1055/s-0042-1743271
17. Cunningham BP, Brazina S, Morshed S, Miclau T 3rd. Fracture healing: A review of clinical, imaging and laboratory diagnostic options. Injury 2017;48(Suppl 1):S69-S75. https://doi.org/10.1016/j.injury
18. Ahmad Khan RD, Yousaf MN, Zain-Ur-Rehman M, Fareed MI, Yasin A. Outcome of open reduction internal
fixation with cross K-wires for supracondylar fracture of humerus in terms of Flynn’s criteria in children. J Pak Med Assoc 2015;65(11 Suppl 3):S186-S189. PMID: 26878517
19. Mazda K, Boggione C, Fitoussi F, Penneçot GF. Systematic pinning of displaced extension-type supracondylar
fractures of the humerus in children. A prospective study of 116 consecutive patients. J Bone Joint Surg Br 2001;
83(6):888-93. https://doi.org/10.1302/0301-620x.83b6.11544
20. Fowler TP, Marsh JL. Reduction and pinning of pediatric supracondylar humerus fractures in the prone position. J Orthop Trauma 2006;20(4):277-81. https://doi.org/10.1097/00005131-200604000-00008
21. Havlas V, Trc T, Gaheer R, Schejbalova A. Manipulation of pediatric supracondylar fractures of humerus in prone position under general anesthesia. J Pediatr Orthop 2008;28(6):660-4. https://doi.org/10.1097/BPO.0b013e318183245b
22. 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. J Pediatr Orthop 2015;35(7):672-6. https://doi.org/10.1097/BPO.0000000000000360
23. Mapes RC, Hennrikus WL. The effect of elbow position on the radial pulse measured by Doppler ultrasonography after surgical treatment of supracondylar elbow fractures in children. J Pediatr Orthop 1998;18(4):441-4. PMID: 9661848
24. Lyons JP, Ashley E, Hoffer MM. Ulnar nerve palsies after percutaneous cross-pinning of supracondylar fractures in children’s elbows. J Pediatr Orthop 1998;18(1):43-5. PMID: 9449100
25. Royce RO, Dutkowsky JP, Kasser JR, Rand FR. Neurologic complications after K-wire fixation of supracondylar
humerus fractures in children. J Pediatr Orthop 1991;11(2):191-4. https://doi.org/10.1097/01241398-199103000-00010
1121-32. https://doi.org/10.2106/JBJS.G.01354
2. Ogden JA. The humerus. En: Ogden JA. Skeletal injury in the child. 3rd ed. New York: Springer-Verlag; 2000.
3. Farnsworth C, Silva P, Mubarak S. Etiology of supracondylar humerus fractures. J Pediatr Orthop 1998;18(1):38-
42. PMID: 9449099
4. Charnley J. Closed treatment of common fractures. 3rd ed. Edinburgh: Churchill Livingstone; 1961, p. 105-15.
5. Minkowitz B, Busch MT. Supracondylar humerus fracture. Current trends and controversies. Orthop Clin North Am 1994;25(4):581-94. PMID: 8090472
6. John SD, Wherry K, Swischuk LE, Phillips WA. Improving detection of pediatric elbow fractures by understanding their mechanics. Radiographics 1996;16(6):1443-60. https://doi.org/10.1148/radiographics.16.6.8946546
7. Mangwani J, Nadarajah R, Paterson JM. Supracondylar humeral fractures in children: ten years’ experience in a
teaching hospital. J Bone Joint Surg Br 2006;88(3):362-5. https://doi.org/10.1302/0301-620X.88B3.16425
8. Joshi T, Koder A, Herman MJ. Staying out of trouble: complications of supracondylar humerus fractures. Instr
Course Lect 2019;68:357-66. PMID: 32032077
9. Kropelnicki A, Ali AM, Popat R, Sarraf KM. Paediatric supracondylar humerus fractures. Br J Hosp Med (Lond)
2019;80(6):312-6. https://doi.org/10.12968/hmed.2019.80.6.312
10. Gartland JJ. Management of supracondylar fractures of the humerus in children. Surg Gynecol Obstet 1959;109(2):145-54. PMID: 13675986
11. De Pellegrin M, Fracassetti D, Moharamzadeh D, Origo C, Catena N. Advantages and disadvantages of the prone position in the surgical treatment of supracondylar humerus fractures in children. A literature review. Injury 2018;49(Suppl 3):S37-S42. https://doi.org/10.1016/j.injury.2018.09.046
12. Guler O, Mutlu S, Isyar M, Mutlu H, Cerci H, Mahirogullari M. Prone versus supine position during surgery for
supracondylar humeral fractures. J Orthop Surg (Hong Kong) 2016;24(2):167-9. https://doi.org/10.1177/1602400209
13. Pavone V, Vescio A, Riccioli M, Culmone A, Cosentino P, Caponnetto M, et al. Is supine position superior to
prone position in the surgical pinning of supracondylar humerus fracture in children? J Funct Morphol Kinesiol
2020;5(3):57. https://doi.org/10.3390/jfmk5030057
14. Sapienza M, Testa G, Vescio A, Panvini FMC, Caldaci A, Parisi SC, et al. The role of patient position in the surgical treatment of supracondylar fractures of the humerus: comparison of prone and supine position. Medicina (Kaunas) 2023;59(2):374. https://doi.org/10.3390/medicina59020374
15. Alton TB, Werner SE, Gee AO. Classifications in brief: the Gartland classification of supracondylar humerus
fractures. Clin Orthop Relat Res 2015;473(2):738-41. https://doi.org/10.1007/s11999-014-4033-8
16. Generoso TO, Pacífico Junior GM, Barcelos FM, Blumetti FC, Braga SR, Ramalho Junior A. The Baumann angle:
An analysis from theory to practice. Rev Bras Ortop (Sao Paulo) 2022;57(6):1039-44. https://doi.org/10.1055/s-0042-1743271
17. Cunningham BP, Brazina S, Morshed S, Miclau T 3rd. Fracture healing: A review of clinical, imaging and laboratory diagnostic options. Injury 2017;48(Suppl 1):S69-S75. https://doi.org/10.1016/j.injury
18. Ahmad Khan RD, Yousaf MN, Zain-Ur-Rehman M, Fareed MI, Yasin A. Outcome of open reduction internal
fixation with cross K-wires for supracondylar fracture of humerus in terms of Flynn’s criteria in children. J Pak Med Assoc 2015;65(11 Suppl 3):S186-S189. PMID: 26878517
19. Mazda K, Boggione C, Fitoussi F, Penneçot GF. Systematic pinning of displaced extension-type supracondylar
fractures of the humerus in children. A prospective study of 116 consecutive patients. J Bone Joint Surg Br 2001;
83(6):888-93. https://doi.org/10.1302/0301-620x.83b6.11544
20. Fowler TP, Marsh JL. Reduction and pinning of pediatric supracondylar humerus fractures in the prone position. J Orthop Trauma 2006;20(4):277-81. https://doi.org/10.1097/00005131-200604000-00008
21. Havlas V, Trc T, Gaheer R, Schejbalova A. Manipulation of pediatric supracondylar fractures of humerus in prone position under general anesthesia. J Pediatr Orthop 2008;28(6):660-4. https://doi.org/10.1097/BPO.0b013e318183245b
22. 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. J Pediatr Orthop 2015;35(7):672-6. https://doi.org/10.1097/BPO.0000000000000360
23. Mapes RC, Hennrikus WL. The effect of elbow position on the radial pulse measured by Doppler ultrasonography after surgical treatment of supracondylar elbow fractures in children. J Pediatr Orthop 1998;18(4):441-4. PMID: 9661848
24. Lyons JP, Ashley E, Hoffer MM. Ulnar nerve palsies after percutaneous cross-pinning of supracondylar fractures in children’s elbows. J Pediatr Orthop 1998;18(1):43-5. PMID: 9449100
25. Royce RO, Dutkowsky JP, Kasser JR, Rand FR. Neurologic complications after K-wire fixation of supracondylar
humerus fractures in children. J Pediatr Orthop 1991;11(2):191-4. https://doi.org/10.1097/01241398-199103000-00010