Is medial open reduction a reliable method in pediatric supracondylar humerus fractures?

Objective: Pediatric Supracondylar Humerus fractures are very common childhood injuries. In the cross pinning method, which is frequently used in the treatment of these fractures, the risk of iatrogenic ulnar nerve injury while sending the medial wire is approximately 3.4%. In this study, we wanted to examine the reliability of medial open reduction and medial mini-open reduction methods that we applied in our clinic. Material and Method: 293 patients aged 1-15 years, who applied to our emergency department or outpatient clinic due to supracondylar humerus fracture between January 2011 and June 2022 and were operated on, were included in our study. Demographic data and application patterns of the patients were examined. The patients were fixed with percutaneous pinning after closed reduction, pinning after mini-incision, or cross pinning after medial open reduction, to ensure appropriate reduction. The patients were followed up clinically and radiologically. Results: Of the 293 patients included in the study, There were nerve injury in 28 (9.4%) preoperatives and arterial injury in 3 (1.01%) preoperatives. Twenty-four patients were treated with closed reduction percutaneous pinning, 128 with medial mini open reduction cross pinning, and 129 with medial open reduction pinning. Iatrogenic ulnar nerve injury was seen in 2 patients. Iatrogenic injuries were seen in the closed reduction percutaneous pinning group. In the radiological Flynn evaluation, it was observed that all patients in the medial open reduction group had excellent results. Conclusion: In the treatment of supracondylar humerus fractures, appropriate reduction is important for good functional and radiological outcome. In our clinic, medial open reduction has been the preferred method to provide a better reduction. Compared to the literature, a higher rate of medial open reduction was applied, and better radiological scores were obtained, although the range of motion was slightly more limited. No iatrogenic nerve injury was observed in patients treated with this method. If appropriate reduction is achieved in closed position, the medial epicondyle should be seen through a mini-incision while inserting the medial wire, and iatrogenic nerve injury should be avoided. Medial open or medial mini open reduction is safer because of the low risk of complication.