Thirty-one pediatric patients treated for SCHF between 2012 and 2018 were evaluated. Written informed consent was obtained from the participants' parents. Inclusion criteria comprised monotrauma supracondylar fractures (G II and III; International Classification of Diseases 812.41) in children under 16 years old at the time of fracture. Exclusion criteria included nondisplaced fractures (G I), follow-up periods shorter than 1 year, patient refusal to participate in the study, and polytrauma. This study was performed in line with the principles of the Declaration of Helsinki. Ethics approval was obtained from our institute’s ethics committee (registry no. 3511).

The study included 21 males and 10 females, with an average age at the time of fracture of 6.8 ± 2.3 years (6.0 ± 2.1 for males and 8.6 ± 1.7 for females). The fracture occurred in the left arm, the nondominant side, in 68% of patients, consistent with epidemiological findings in the literature [13]. We categorized patients into two groups based on the Wilkins-modified Gartland classification: 19 fractures were classified as type II, with nine classified as type IIa and 10 as type IIb, while 12 fractures were classified as type III. We managed the fractures according to the severity of displacement: nine patients with G IIa fractures underwent closed reduction with sedation followed by casting, but one patient from this group exhibited a loss of reduction during the follow-up 1 week after casting and needed surgical reduction and fixation with K-wires. In the remaining 22 patients, 10 had G IIb fractures, while 12 had G III fractures; all of them necessitated surgical intervention. Among this group, 18 patients underwent closed reduction followed by fixation with two crossed pins (see Figs. 1 and 2), one patient underwent fixation with three crossed pins (two lateral and one medial), two patients were treated with two lateral and parallel K-wires, and one patient underwent fixation with a plate and screws (Table 1).

Intraoperative antero-posterior radiograph: reduction and pinning fixation with two crossed pins

Intraoperative lateral view radiograph: reduction and pinning fixation with two crossed pins

A total of five orthopedic surgeons participated in the surgical procedures.

Our study utilized a modified version of the the DASH (Disabilities of the Arm, Shoulder, and Hand; m-DASH) questionnaire, tailored for pediatric use. This version comprises 10 questions. By assessing pain, stiffness, and difficulties in performing daily activities, the questionnaire aims to provide an estimated score reflecting the level of disability caused by the injury. The questionnaire consists of five response options for the first three questions (none, mild, moderate, severe, or unable), and three response options for the remaining questions (none, moderate, or severe). The number of response options is reduced due to children's difficulty in differentiating between various degrees of movement difficulty (Fig. 3).

All 31 patients were evaluated using the m-DASH score, but only 27 patients consented to follow-up assessments, which included measurements of elbow range of motion (ROM), carrying angle, and grip strength. These metrics were assessed using a goniometer and a digital hand dynamometer (Kyto Fitness Technology, Guangdong, China; grip strength measurement of 200 lbs/90 kgs hand grip) and compared with those of the contralateral normal arm.

Normal values for flexion and extension in adults range from 140° to 150° and from 0° to 5°, respectively. In our pediatric sample, we calculated the mean, standard deviation, and confidence interval for the healthy limb to establish a specific range of normal values. Similarly, we applied this process to extension, pronation, supination, and carrying angle. Based on the statistical analysis conducted, the reference normal value (confidence interval) for elbow flexion is 140–144°; for extension, it ranges between − 6° and 0°; for pronation, 89–93°; and for supination, 92–99°. Finally, for the cubital angle, the specific normal values for our sample are 12–16° of valgus.

Flynn’s criteria [14] were employed to categorize the outcomes of SCHF. These criteria consider residual deformity and functional factors separately, based on the loss of carrying angle and flexion reduction. In their 1976 study, Flynn et al. evaluated cases of supracondylar fracture over a 16-year period and established criteria to determine whether the difference in angle between the fractured and healthy elbows can be considered satisfactory or unsatisfactory. According to this classification, the results are deemed excellent when the difference in angle between the fractured and healthy elbows falls between 0° and 5°, good when it is between 6° and 10°, and a fair/modest recovery when the angle difference ranges from 11° to 15°. A difference greater than 15° is considered poor (Table 2). Patient outcomes, according to Flynn's criteria, were correlated with treatment and fracture type.

The medium-term results were analyzed using the healthy side of the same patient as a control, as it exhibited no morbidity significant enough to affect statistical measurements. To assess differences in continuous variables such as angles and strength, Student's t-test was employed. The analysis encompassed all fractures, with the healthy limb compared with the fractured one. Subsequently, clinically observed functional outcomes were correlated with different treatment modalities. The study's significance threshold was set at a p value < 0.05 (a p value < 0.01 was highly significant). The theory underlying the t-test aims to reject the null hypothesis and thus to suggest that the difference in data, such as the angle disparity, is not due to chance but is significantly influenced by the fracture's impact on clinical data. Data analysis was performed using the statistical software SPSS Statistics.