Early functional and operative outcomes of three open surgical approaches compared with closed reduction and percutaneous pinning in Gartland type III pediatric supracondylar humerus fractures

Supracondylar humerus fractures (SHFs) are commonly treated with closed reduction and percutaneous pinning (CRPP); however, open reduction is required in selected cases. To compare early functional and operative outcomes of anterior, lateral, and posterior open reduction techniques, using CRPP as a reference standard. This retrospective study included 60 pediatric patients with Gartland type III SHFs (CRPP, n = 15; anterior, n = 15; lateral, n = 15; posterior, n = 15). Outcomes included operative time, fluoroscopy use, union time, joint range of motion, Flynn functional and cosmetic scores, and complication rates. Compared with open techniques, CRPP demonstrated shorter operative time (30.5 ± 5.4 vs. 55.4 ± 7.2 min, P < 0.001), earlier union (28.6 ± 2.7 vs. 39.0 ± 5.9 days, P < 0.001), and superior cosmetic outcomes ( P < 0.001). Flexion limitation was greater in the open surgery group ( P = 0.030), while extension limitation was similar between groups ( P = 0.068). Functional Flynn scores did not differ significantly ( P = 0.151). Complication rates were low and comparable ( P = 1.000). Among open approaches, the posterior technique was associated with longer operative time, delayed union, greater motion limitation, and poorer functional and cosmetic outcomes ( P < 0.05 for all). Among open approaches, the anterior technique demonstrated more favorable early outcomes; however, these findings should be interpreted in the context of potential differences in fracture complexity between groups. CRPP remains the standard treatment and provides superior perioperative and cosmetic outcomes.