Risk factors for loss of fixation in pediatric supracondylar humeral fractures.

The aim of this study was to determine the risk factors for loss of fixation in pediatric supracondylar humeral fractures.The data were analyzed regarding assessed loss of fixation in 256 supracondylar fractures from January 2010 to December 2012, all of which were treated by closed or open reduction and Kirschner wire fixation. The confounding factors that were thought to cause loss of reduction were collected. Multivariate logistic regression analysis was performed to predict risk factors.Reduction was lost in 14.8% of the patients. Poor surgical technique was significantly higher in the cases with lost reduction (odds ratio: 15.21). Additionally, cases with only lateral pins placement (odds ratio: 2.57), Gartland type 3 fractures (odds ratio: 2.38), and, obesity with a BMI ≥ 25 (odds ratio: 14.35) had a significantly higher risk of losing reduction and fixation. Other factors including age, energy type of injury, time of surgery, and time to surgery were not associated with risk.The loss of reduction following fracture fixation is associated with poor surgical technique,fixation with lateral pinning only, Gartland type 3 fractures, and pediatric obesity (BMI > 25). The stability of fracture fixation in pediatric supracondylar fractures is largely dependent on the use of effective fixation techniques. Cross pinning provides a more stabile fixation than lateral pinning.