Emergency Room Closed Reduction Versus In Situ Splinting in the Treatment of Pediatric Supracondylar Humerus Fractures

Purpose: Displaced supracondylar fractures are usually treated with open or closed reduction and percutaneous pinning. Prior to 2012, patients presenting to our institution with a displaced fracture underwent a closed reduction in the emergency department (ED) prior to repeat closed reduction and pinning in the operating room (OR). Since 2012, we have transitioned to a protocol in which all of these patients are splinted in-situ without ED reduction. The purpose of this study is to investigate if there are differences in outcomes or complications between these two management methods. Methods: Patients less than 10 years old with a Gartland type II or III supracondylar humerus fracture between 2008 and 2016 were included. Cases of polytrauma were excluded. Patients were separated into two groups depending on whether or not closed reduction was performed in the ED. All patients proceeded to surgery. Radiographic outcomes were assessed at follow-up. The Fisher's exact test was used for categorical variables and the Wilcoxon rank sums tests for continuous variables. Results: 157 patients were included, 89 with reduction in the ED and 68 without. There was no significant difference between the groups related to demographic factors or fracture characteristics. Patients managed without reduction in the ED had a lower average delay from ED to OR compared to those treated with reduction (16 hours vs. 22 hours, p