Conservative versus open reduction internal fixation (ORIF) for pediatric supracondylar humerus fractures gartland type II and III: a systematic review and meta-analysis
Keywords:conservative, open reduction internal fixation, supracondylar humerus fracture.
Introduction: Displaced supracondylar humerus fracture in children presents a challenge for surgeons, as the treatment of choice is still controversial, considering the functional and cosmetic outcomes as well as the surgical risks it might carry. This study aims to compare the outcomes of two kinds of treatments for the pathology: Conservative versus Open Reduction with Internal Fixation (ORIF).
Methods: A systematic review using PubMed and Google Scholar was conducted based on PRISMA guideline. Inclusion criteria were studies with samples aged <18 years old, comparing conservative and ORIF procedure for Supracondylar Humerus Fractures Gartland Type II and III, with Flynn criteria as the main outcome. Studies of only one surgical technique modality, Gartland type I, and case reports were excluded. For the meta-analysis, a total of 3 studies were included and fixed effect model was used to pool the result. In each study, mean difference (MD) with a 95% confidence interval (CI) was calculated for dichotomous outcomes using Review Manager 5.3.
Results: Fifty-one patients aged 1-14.6 years old were included in the analysis. Male and female were equally affected, and conservative procedure was done more often than ORIF. Based on Flynn’s Criteria, satisfactory outcomes (excellent or good) were achieved in 58.62% of patients in the conservative and 86.36% in the ORIF group, indicating a significant difference (Heterogeneity, I2 = 20%; WMD, 0.23; 0.06 to 0.91; P=0.04).
Conclusion: Current systematic review and meta-analysis suggest that ORIF offers superior functional and cosmetic outcomes compared to conservative methods for pediatric displaced supracondylar humerus fracture.
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