Anterior approach for pediatric supracondylar humerus fractures: A systematic review
Bibliographic record
Abstract
Background and Purpose: Open reduction is rarely performed in pediatric supracondylar humerus fractures. However, clear evidence is lacking regarding the optimal open approach to achieve satisfactory results. The anterior approach provides direct visualization of the fracture and excellent exposure to neurovascular structures, although its utilization is less common. The objective of this study was to review the indications, outcomes, and complications associated with the anterior approach for open reduction of these fractures. Methods: Our protocol was registered at PROSPERO: CRD42023446923. MEDLINE/PubMed, Embase, Web of Science, Clinicaltrials.gov, and Cochrane Library were searched from database inception to search date (December 2023) and screened in duplicate for relevant studies. Data were collected regarding patient demographics, indications for open reduction, Flynn’s functional and cosmetic outcomes, and complications. Study quality was assessed using the Methodological Index for Non-Randomized Studies Criteria. Results: A total of 19 studies involving 483 patients were included. One study was classified as Level 2 evidence, ten as Level 3, and eight as Level 4. The mean MINORS score was 13.05 ± 3.47. The primary indication for open reduction was failed closed reduction, observed in 46% of patients. 97.7% and 98.6% of patients achieved Flynn’s functional and cosmetic satisfactory results, respectively. The postsurgical neurovascular injury rate was 1.4%. One patient required reintervention. Conclusion: The anterior approach is safe and effective for managing pediatric supracondylar humerus fractures requiring open reduction. Level of Evidence: Systematic review of Level 2-4 evidence studies. Antecedentes y Objetivo: La reducción abierta rara vez es necesaria en las fracturas supracondíleas de húmero pediátrica. Sin embargo, falta evidencia sobre cuál es el abordaje óptimo para obtener resultados satisfactorios. El abordaje anterior facilita una visión directa de la fractura y una excelente exposición de las estructuras neurovasculares, aunque su uso es poco común. El objetivo de este estudio fue revisar las indicaciones, resultados, y complicaciones asociadas con el abordaje anterior para la reducción abierta de estas fracturas. Métodos: Nuestro protocolo se registró en PROSPERO: CRD42023446923. La búsqueda se realizó en MEDLINE/PubMed, Embase, Web of Science, Clinicaltrials.gov, y Cochrane Library desde inicios hasta diciembre 2023. Se realizó screening por duplicado. Se recogieron datos demográficos, indicaciones para el abordaje abierto, puntuación de Flynn funcional y estética y complicaciones. La calidad de los estudios se evaluó con Methodological Index for Non-Randomized Studies Criteria (MINORS). Resultados: 19 estudios que agrupaban 483 pacientes fueron incluidos. Un estudio se clasificó con nivel de evidencia 2, diez con nivel 3, y ocho con nivel 4. La puntuación media MINORS fue 13.05 ± 3.47. La indicación principal para el abordaje abierto fue el fracaso de la reducción cerrada, reportada en 46% de pacientes. El 97.7% y 98.6% de los pacientes lograron un Flynn funcional y cosmético satisfactorio, respectivamente. La tasa de lesiones neurovasculares postquirúrgicas fue 1.4%. Un paciente fue reintervenido. Conclusiones: El abordaje anterior es seguro y efectivo en el maneco de fracturas supracondíleas de húmero pediátricas cuando se requiera un abordaje abierto. Nivel de Evidencia: Revisión sistemática de estudios con nivel de evidencia 2-4.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.013 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.006 | 0.005 |
| Bibliometrics | 0.007 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".