Supracondylar humeral fractures are common in children, but there are no classification systems or radiological parameters that predict the likelihood of having to perform an open reduction. In a retrospective case-control study we evaluated the use of the medial spike angle and fracture tip-skin distance to predict the mode of reduction (closed or open) and the operating time in fractures with posterolateral displacement. A total of 21 patients (4.35) with a small medial spike angle ( 45° were randomly selected as controls. The medial spike group had significantly smaller fracture tip-skin distances (p < 0.001), longer operating times (p = 0.004) and more complications (p = 0.033) than the control group. There was no significant difference in the mode of reduction and a composite outcome measure. After adjustments for age and gender, only fracture tip-skin distance remained significantly associated with the operating time (p = -0.724, p = 0.042) and composite outcome (OR 0.863 (95 confidence interval 0.746 to 0.998); p = 0.048).Paediatric orthopaedic surgeons should have a lower threshold for open reduction when treating patients with a small medial spike angle and a small fracture tip-skin distance.
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