Comparison between closed reduction with percutaneous pinning and open reduction with pinning in children with closed totally displaced supracondylar humeral fractures : a randomized controlled trial

Abstract

Objectives: To measure the difference in Baumann’s angle of the fracture side from the normal side and compare between closed and open reduction group., To compare the satisfaction, the complication rates, the cost effectiveness, the range of motion between two groups of treatment., To consider which method should be the treatment of choice for children with totally displace supracondylar humeral fracture. Design: A randomize controlled clinical trial. Setting: Siriraj hospital, Faculty of Medicine, Mahidol University. Patients and Intervention: Twenty children with closed totally displaced supracondylar humeralfracture were ramdomly assigned to group A (closed reduction with pinning) in 10 cases and group B (open reduction with pinning) in 10 cases. Results: The general characteristics in both groups are not differect in age (mean ± S.D. = 6.9 ± 3.1, 6.3 ± 2.8, P= 0.66.95% CI -2.2, 3.4), sex, side, displacement and nerve injury preoperatively. All cases healed in good range of motion and results. The Baumann’s angle difference = 2.53 ± 1.8 in group A and 2.09 ± 1.7 in group B with no statistical significant difference (P = 0.44, 95%CI = -1.2, 2.08) and also no difference in satisfaction and complications. But the total cost in provider’s perspective and parents’ perspective were different (P=0.029, <0.001 respectively) Conclusions: Closed reduction should be considered first as the treatment of choice and if it fails open reduction can be performed and will end up in good result.