Anterior Versus Posterior Surgical Approaches to Pediatric Supracondylar Humerus Fracture

Objectives: Gartland type III supracondylar humerus fractures frequently occur as traumatic injuries in children and often require surgical intervention. This study aimed to compare the efficacy of anterior and posterior surgical approaches to treating these fractures.Methods: This retrospective study analyzed ۴۸ patients under the age of ۱۰ with Gartland type III fractures. These patients were treated with either the anterior (n=۲۳) or the posterior approach (n=۲۵). At three and six months postsurgery, elbow range of motion (ROM), complications, and functional/cosmetic outcomes were assessed using Flynn's criteria.Results: No significant differences were found between the groups regarding age or gender. At three months, the anterior group showed significantly better extension (-۸.۲۶° vs. -۱۳.۲۰°, P=۰.۰۳۲), but this difference was not significant at six months. No significant differences were observed in flexion, pronation, or supination at any time point. Both groups showed significant ROM improvements from three to six months (P<۰.۰۰۱); however, these improvements were slightly below the normative values (P<۰.۰۵). The overall complication rates were low and comparable between the two approaches (anterior: ۸.۷۰%; posterior: ۱۲.۰۰%; P=۰.۷۰۰), primarily comprising reversible ulnar nerve injuries and superficial infections. Furthermore, based on Flynn's criteria, there were no significant differences in functional or cosmetic outcomes, with most patients achieving excellent or good results in both groups.Conclusion: Both anterior and posterior approaches for pediatric Gartland type III supracondylar humerus fractures resulted in satisfactory outcomes. Therefore, the choice of surgical approach will depend on patient-related factors and surgeons’ preferences. Level of evidence: III

Keywords:

Anterior Approach , Elbow Range of Motion , pediatric orthopedics , Posterior Approach , Supracondylar humerus fracture , surgical outcomes