Clinical and Perioperative Correlates of Poor Flynn Outcome After Triceps-Sparing Open Reduction of Gartland Type III Pediatric Supracondylar Humeral Fractures

Open Access

Abstract

Introduction: Most children with displaced supracondylar humeral fractures achieve satisfactory functional recovery after operative treatment, although a small proportion develop Poor outcomes. Information regarding clinical and perioperative characteristics associated with Poor Flynn outcome after triceps-sparing open reduction remains limited. Aim: To identify clinical and perioperative correlates of Poor Flynn outcome after triceps-sparing open reduction of Gartland type III pediatric supracondylar humeral fractures. Methods & Materials: This prospective concurrent observational study was conducted at the National Institute of Traumatology and Orthopaedic Rehabilitation, Dhaka, Bangladesh, from July 2020 to June 2022. Forty-four children aged 5-10 years with closed Gartland type III supracondylar humeral fractures and failed closed reduction underwent triceps-sparing posterior open reduction with crossed Kirschner-wire fixation and were followed for up to 24 weeks. Final outcome was assessed using Flynn's criteria. For analysis, Poor outcome was defined as a Flynn grade of Poor, corresponding to >15° loss of carrying angle and/or elbow motion, while Excellent, Good, and Fair grades, representing losses of 0-15°, were grouped as non-Poor. Clinical and perioperative characteristics were compared between Poor and non-Poor groups using the Mann-Whitney U test, Fisher's exact test, and Fisher-Freeman-Halton exact test, as appropriate. Multivariable regression was not performed because only four Poor outcomes occurred. Results: Poor Flynn outcome occurred in 4/44 (9.1%) children. The median injury-to-operation interval was significantly longer in the Poor group than in the non-Poor group, 7.0 versus 5.0 days, p=0.005. Poor outcome occurred in 4/11 (36.4%) children operated on day 7 compared with 0/33 (0.0%) operated on days 4-6, p=0.002. All 4 children with postoperative triceps power of Medical Research Council grade 4/5 had Poor outcomes, compared with none of the 40 children with grade 5/5 power, p<0.001. No significant associations were observed for age, sex, injury mechanism, affected side, healing time, or recorded complications. Conclusion: Longer injury-to-operation interval and reduced postoperative triceps power were the principal correlates of Poor Flynn outcome in this cohort. These findings are exploratory and should be confirmed in larger studies.