e-ISSN: 2722-3558 Sriwijaya Journal of Surgery [SJS] https://sriwijayasurgery.
Baumann's Angle and Shaft-Condylar Angle as Predictors of Functional Outcome After Surgery for Neglected Supracondylar Humerus Fractures in Children Bunyamin1*.
Nur Rachmat Lubis1.
Mochammad Ridho Nur Hidayah1.
Irfannuddin2 1Department of Orthopedics Surgery and Traumatology.
Universitas Sriwijaya.
Palembang.
Indonesia 2Medical Study Program.
Faculty of Medicine.
Universitas Sriwijaya.
Palembang.
Indonesia
ARTICLE
ABSTRACT
INFO
Keywords:
Baumann's angle Functional outcome Neglected fracture Shaft-condylar angle Supracondylar humerus fracture *Corresponding author:
Bunyamin E-mail address:
Bunyaminismail@gmail.
All authors have reviewed and approved the Anal version of the manuscript.
https://doi.
org/10.
37275/sjs.
Introduction: Neglected supracondylar humerus fractures in children remain a significant source of functional impairment, particularly in developing countries.
Radiographic parameters such as Baumann's angle and shaft-condylar angle have been proposed as indicators of fracture alignment, yet their association with functional outcomes after surgical intervention has not been systematically evaluated in neglected cases within Southeast Asian populations.
Methods: This cross-sectional observational analytic study examined medical records of 28 children treated surgically for neglected supracondylar humerus fractures at Dr.
Mohammad Hoesin General Hospital.
Palembang.
Indonesia.
Radiographic measurements of Baumann's angle and shaft-condylar angle were obtained preoperatively and at three months postoperatively.
Functional outcomes were assessed using the Flynn criteria.
Receiver operating characteristic curve analysis with the Youden index determined optimal cut-off values.
Results: Mean age was 04 A 3.
0 years, with male predominance .
%) and left-sided involvement .
4%).
Mean surgical delay was 188.
4 A 166.
3 days.
Postoperatively, 100% achieved satisfactory cosmetic outcomes, while functional satisfaction occurred in 64.
3% of patients.
Normal Baumann's angle was associated with satisfactory functional outcomes .
dds ratio 18.
667, 95% confidence interval 533Ae137.
587, p=0.
The shaft-condylar angle with population-specific cut-off of 41.
80A demonstrated a significant association .
dds ratio 11.
95% confidence interval 1.
048Ae122.
549, p=0.
Absolute risk difference for Baumann's angle was 62.
0%, and for the shaft-condylar angle, the cutoff was 53.
Conclusion: Normal Baumann's angle was strongly associated with satisfactory functional outcomes following surgical management of neglected supracondylar humerus fractures.
A populationspecific shaft-condylar angle cut-off of 41.
80A showed a significant association with functional outcomes.
Both parameters warrant consideration during operative planning, with multivariate confirmation recommended in larger prospective studies.
Introduction supracondylar humerus fractures.
Supracondylar humerus fractures represent the population, accounting for 40Ae60% of all pediatric Unlike acute fractures managed with simple elbow injuries globally.
These injuries typically occur reduction and percutaneous pinning, neglected cases following falls on an outstretched hand, with most frequently require corrective osteotomy to restore cases presenting acutely for prompt treatment.
anatomical alignment.
The functional outcomes in However, a subset of children in developing countries presents with chronic, untreated fractures that have reconstruction during surgery.
Restoring normal radiographic parameters is thought to correlate with present unique challenges for the treating orthopedic Neglected better postoperative function and cosmesis.
Baumann's angle, defined as the angle between the horizontal and a line connecting the lateral condyle to radiographs and postoperative radiographs at three months of follow-up.
the center of the lateral metaphyseal cortex, has been recognized as an important measure of fracture Inclusion and exclusion criteria reduction quality in acute cases.
5,6 Similarly, the Inclusion criteria were: confirmed diagnosis of shaft-condylar angle, measured between the humeral neglected supracondylar humerus fracture.
age 3Ae17 shaft and the line connecting the epicondyles, has years at time of injury.
surgical intervention with been proposed as an additional indicator of proper However, the prognostic value of these complete radiographic data .
reoperative and three- radiographic parameters with respect to functional month postoperativ.
and complete assessment of outcomes in neglected cases has not been well functional outcomes using Flynn criteria at three months postoperatively.
Exclusion criteria were: acute Southeast Asian populations where such injuries remain prevalent.
This study was undertaken to systematically and/or evaluate the association between Baumann's angle neurovascular compromise.
and incomplete follow-up shaft-condylar functional outcomes in children treated surgically for Variables and measurements hypothesized that restoration of normal radiographic Radiographic measurements were performed on parameters would be associated with satisfactory standardized anteroposterior and lateral radiographs functional outcomes according to the Flynn criteria, of the elbow.
Baumann's angle was measured as the thereby validating these measurements as important angle between the horizontal and a line connecting the surgical targets in the treatment of neglected cases.
lateral condyle to the center of the lateral metaphyseal cortex on the anteroposterior view.
The shaft-condylar Methods angle was measured as the angle between the Study design and setting longitudinal axis of the humeral shaft and the line This was a cross-sectional observational analytic connecting the medial and lateral epicondyles on the study conducted at Dr.
Mohammad Hoesin General Hospital.
Palembang.
Indonesia, a tertiary referral obtained on initial presentation radiographs, and orthopedic center in Southeast Asia.
Medical records postoperative measurements were performed at three months follow-up.
supracondylar humerus fractures were reviewed Preoperative Functional outcomes were assessed using the Flynn criteria, which evaluate both cosmetic and functional aspects of the fracture outcome.
Cosmetic Population and sampling outcomes are categorized as excellent, good, or fair The study population consisted of children aged 3Ae based on loss of motion and carrying angle.
Functional 17 years who presented with neglected supracondylar humerus fractures and underwent surgical treatment.
unsatisfactory based on the limitation of pronation All patients had sustained the injury at least four and supination.
Patient demographics, including age, weeks prior to surgical intervention, meeting the gender, time from injury to surgical intervention, and surgical technique employed, were recorded from The included patients who had complete radiographic medical records.
Statistical analysis Descriptive the magnitude of associations.
The absolute risk variables and presented as mean A standard deviation difference was computed to assess the clinical significance of the findings.
for normally distributed continuous variables and as median with range for non-normally distributed data.
Ethical approval Categorical variables were expressed as frequencies This study was approved by the institutional ethics and percentages.
Bivariate logistic regression analysis committee of the Faculty of Medicine.
Universitas was performed to assess the association between Sriwijaya.
radiographic parameters and functional outcomes.
accordance with the Declaration of Helsinki and Receiver operating characteristic curve analysis with institutional guidelines for human subjects research.
All the Youden index was used to determine optimal cutoff values for continuous radiographic measurements.
Fisher's exact test was used for statistical testing due Results The study included 28 children with neglected to small cell frequencies.
A p-value less than 0.
05 was considered statistically significant.
Odds ratios with 95% confidence intervals were calculated to quantify presented in Table 1.
Patient Table 1.
Demographic and clinical characteristics .
Variable Age .
Gender Male Female Time to surgery .
Treatment Osteotomy K-wire Calestosis K-wire Fracture side Left n (%) Ai Mean A SD / Median (Rang.
04 A 3.
0 / 9 .
Ae.
Ai Ai Ai 4 A 166.
3 / 120 .
Ae.
Ai Ai 20 .
Ai As shown in Table 1, the mean age was 9.
04 A 3.
All patients .
%) achieved satisfactory cosmetic years with male predominance .
0%).
Left-sided outcomes on the Flynn criteria.
Specifically, 57.
fractures were more common .
4%), and the median attained excellent cosmetic results, 35.
7% achieved time to surgery was 120 days, with considerable good outcomes, and 7.
1% had fair cosmetic results.
ange 24Ae720 day.
The majority of patients contrast, functional outcomes were less uniform:
percutaneous K-wire fixation.
Postoperative achieved fair functional outcomes, and 35.
7% had outcomes at three months are summarized in Table 2.
unsatisfactory functional results, yielding an overall functional satisfaction rate of 64.
Table 2.
Postoperative outcomes at 3 months .
Variable Baumann's Angle (A) Normal .
Ae81A) Abnormal Shaft-Condylar Angle (A) Normal .
Ae50A) Abnormal Flynn Cosmetic Score Satisfactory Ae Excellent Satisfactory Ae Good Satisfactory Ae Fair Flynn Functional Score n (%) Ai 19 .
Ai 17 .
Mean A SD (Rang.
45 A 8.
32Ae88.
Ai Ai 94 A 7.
54Ae59.
Ai Ai 16 .
Ai Ai Ai Bivariate analysis results assessing the association condylar angle with standard reference range .
Ae50A) between radiographic parameters and functional showed an association that did not reach statistical outcomes are presented in Table 3 and visualized in significance (OR 3.
900, p=0.
However, when the forest plot (Figure .
Normal Baumann's angle analyzed using the population-specific cut-off value of demonstrated a strong association with satisfactory 80A, the shaft-condylar angle demonstrated a functional outcomes, with an odds ratio of 18.
significant association with functional outcomes (OR .
% CI 2.
533Ae137.
587, p=0.
Patients with 333, 95% CI 1.
048Ae122.
549, p=0.
, indicating normal Baumann's angle were over 18 times more that values less than 41.
80A were associated with likely to achieve satisfactory functional outcomes improved functional results.
compared to those with abnormal values.
The shaft- Table 3.
Association between radiographic parameters and functional outcomes.
Analysis BA normal .
Ae81A) BA abnormal SCA normal .
Ae50A) SCA abnormal BA cut-off < 76.
BA cut-off Ou 76.
SCA cut-off < 41.
Satisfactory n/N (%) 16/19 .
2/9 .
13/17 .
5/11 .
14/18 .
4/10 .
17/23 .
Unsatisfactory n/N (%) 3/19 .
7/9 .
4/17 .
6/11 .
4/18 .
6/10 .
6/23 .
OR .
% CI)
p-value 667 .
533Ae137.
Ref 900 .
762Ae19.
Ref 250 .
975Ae28.
Ref 333 .
048Ae122.
* Statistically significant .
< 0.
Fisher's exact test used.
OR = odds ratio.
CI = confidence interval.
BA =
Baumann's angle.
SCA = shaft-condylar angle.
Receiver The optimal cut-off value for Baumann's angle identified optimal cut-off values for both radiographic was determined to be 76.
40A, while the optimal cut-off parameters, as shown in Table 4 and Figure 2.
The for the shaft-condylar angle was 41.
These cut-off values were selected using the Youden index to revealed area under the curve values of 0.
578 for maximize the sum of sensitivity and specificity.
Baumann's angle and 0.
647 for the shaft-condylar Figure 1.
Forest plot demonstrating odds ratios and 95% confidence intervals for radiographic parameters predicting functional outcomes.
Table 4.
Receiver operating characteristic curve analysis.
Parameter AUC .
% CI) Optimal Cut-off p-value Baumann's angle 578 .
301Ae0.
Shaft-condylar angle 647 .
405Ae0.
Figure 2.
Receiver operating characteristic curves for Baumann's angle and shaft-condylar angle predicting functional outcomes, with optimal cut-off values identified.
The had normal shaft-condylar angle values .
Ae50A), radiographic parameters among patients is depicted in 3% had abnormal measurements.
These Figure 3.
Among the 28 patients studied, 67.
findings reflect the variability in surgical restoration of demonstrated normal Baumann's angle .
Ae81A), anatomical parameters in neglected supracondylar 1% had abnormal values.
Similarly, 60.
humerus fractures.
Figure 3.
Distribution of radiographic parameters (Baumann's angle and shaft-condylar angl.
in the study population, categorized by normality classification.
Discussion This study systematically examined the prognostic .
% CI 533Ae137.
587, p=0.
This relationship is clinically and statistically significant, value of two radiographic parametersAiBaumann's Baumann's angle should be considered a critical shaft-condylar angleAiin neglected supracondylar humerus fractures in a supracondylar humerus fractures.
In our cohort, cohort of 28 children.
Our findings demonstrate that restoration of normal Baumann's angle is strongly Baumann's angle achieved satisfactory functional associated with satisfactory functional outcomes, outcomes, compared to only 22.
2% of those with while the shaft-condylar angle, with a population- abnormal values.
This 62% absolute risk difference emphasizes the practical cut-off association with functional results.
The key finding of this investigation is the strong functional outcomes following surgical management of achieving a normal Baumann's angle during the operative procedure.
association between normal Baumann's angle and Baumann's angle represents the angle between the satisfactory functional outcomes, with an odds ratio of horizontal and a line from the lateral condyle to the center of the lateral metaphyseal cortex, and it has specific and condition-specific cut-off values when long been recognized as an indicator of fracture reduction quality in acute supracondylar humerus decision-making, particularly in regions or specific 9 The normal range is typically defined as 64Ae patient populations where morphological variations 81A in the pediatric population.
Our findings extend may exist.
this knowledge to the treatment of neglected cases.
Our cohort demonstrated remarkable cosmetic where restoration of normal anatomy is complicated by existing malunion.
The strong association we satisfactory cosmetic results on the Flynn criteria.
observed may reflect the geometric accuracy required This universal cosmetic success is noteworthy because to restore proper elbow kinematics and alignment.
it suggests that modern surgical techniques for When Baumann's angle is abnormal, there is often correcting neglected supracondylar humerus fractures residual varus or valgus deformity, which can result in are highly effective at addressing the cosmetic deformity that often manifests as prominent lateral supination, and overall functional elbow mobility.
The condylar prominence, altered carrying angle, and surgeons involved in this study achieved normal other visible abnormalities.
12 However, the functional Baumann's angle in 67.
9% of cases through careful outcomes were less uniformly favorable, with only 3% achieving satisfactory functional results.
This substantial improvement from the severely abnormal values present preoperatively due to malunion and outcomes underscores an important clinical principle:
healing in poor position.
anatomical restoration, while necessary, does not The shaft-condylar angle, measured between the guarantee perfect functional restoration.
The disparity humeral shaft and the interepicondylar line on lateral radiographs, also emerged as a significant predictor of immobilization, soft tissue contractures that develop functional outcomes in this study.
However, the during the chronic phase of neglected fractures, and relationship was more nuanced than with Baumann's potential neuromuscular changes from the prolonged Using the standard reference range of 30Ae50A, period of malposition prior to surgery.
shaft-condylar angle showed an association that The absolute risk difference values computed in approached but did not reach statistical significance this study provide additional insight into the clinical (OR 3.
900, 95% CI 0.
762Ae19.
951, p=0.
This magnitude of the associations observed.
For a normal finding suggests that the conventional reference Baumann's angle, the absolute risk difference was ranges derived from healthy populations may not be 0%, meaning that achieving a normal Baumann's optimal for predicting outcomes in neglected fractures.
We therefore analyzed shaft-condylar angle using a functional outcomes by this proportion.
13 For the population-specific shaft-condylar angle using the cut-off of 41.
80A, the determined through receiver operating characteristic absolute risk difference was 53.
These figures analysis to be 41.
Using this cut-off, shaft- translate directly to clinical practice: of every 100 condylar angle demonstrated a statistically significant association with functional outcomes (OR 11.
333, 95%
supracondylar humerus fractures, if we could achieve CI 1.
048Ae122.
549, p=0.
Patients with shaft- normal Baumann's angle in all cases, we might expect condylar angle less than 41.
80A were over 11 times approximately 62 additional patients to experience more likely to achieve satisfactory functional outcomes satisfactory functional outcomes.
This magnitude of compared to those with values Ou41.
This finding effect is substantial and justifies making restoration of highlights the importance of considering population- these parameters a priority during operative planning.
cut-off Our study population consisted predominantly of male patients .
%) with left-sided involvement .
4%), with a mean age 9.
04 years.
The prolonged radiographic parameters may serve as a surrogate for .
edian 24Ae720 Third, restoration of normal three-dimensional anatomy, characteristic of neglected fractures in developing which encompasses many other anatomical features countries, where access to specialized orthopedic care beyond just these two angles.
may be limited.
The considerable range in surgical The receiver operating characteristic analysis delay reflects the diverse pathways by which these performed in this study identified optimal cut-off patients reach definitive care, ranging from those who values that maximized sensitivity and specificity for presented relatively soon after injury but with initial predicting functional outcomes.
The Baumann's angle reduction attempts, to those who cut-off of 76.
40A and shaft-condylar angle cut-off of presented years after the initial trauma.
Despite this 80A represent values derived from the study heterogeneity in presentation timing, the strong population's data and may be particularly relevant for association between radiographic parameters and similar populations in Southeast Asia.
However, it is functional outcomes remained evident, suggesting important to note that these are derived values based that the relationship is robust across different clinical on small sample size, and larger prospective studies are needed to validate these cut-off values and The surgical treatment in our cohort consisted The area under the curve values .
578 for Baumann's percutaneous K-wire fixation .
4%), with one patient angle, 0.
647 for shaft-condylar angl.
indicate modest discriminatory ability, suggesting that while these determine whether they apply to other populations.
Lateral parameters contribute meaningfully to functional correcting varus deformity in neglected supracondylar prediction, other factors not captured in this analysis humerus fractures, as it addresses the primary also influence functional outcomes.
geometric derangement while minimizing soft tissue The study had several notable strengths.
The The consistent use of percutaneous pinning retrospective review of consecutive cases minimizes reflects current international best practice in pediatric selection bias, and the standardized measurement of orthopedic surgery, allowing for stable fixation while radiographic parameters by experienced personnel reducing infection risk and morbidity associated with enhances measurement reliability.
17 The use of well- open reduction techniques.
Several mechanisms may explain the strong (Flynn facilitates comparison with international literature.
association between normal radiographic parameters The and functional outcomes observed in this study.
First, postoperatively represents a reasonable timeframe for restoration of normal Baumann's and shaft-condylar healing and initial rehabilitation, though longer follow- angles likely normalizes the biomechanical loading up might reveal additional functional changes.
The and articular surface alignment of the elbow joint.
When these angles are abnormal, the lateral force- .
redominantly coupling and stability of the ulnohumeral articulation reduces confounding by surgical technique and allows the focus to remain on radiographic parameters as instability or altered stress Second, achieving normal angles during osteotomy may require careful attention to soft tissue balancing and release K-wire outcome predictors.
However.
The small sample size .
limits statistical power and results in wide confidence Future research should include prospective studies intervals for some estimates, particularly for the odds with larger sample sizes to validate the cut-off values ratio associated with shaft-condylar angle.
This identified in this investigation.
Multivariate analysis reflects the relative rarity of neglected supracondylar humerus fractures, even in a tertiary referral center.
Baumann's angle, shaft-condylar angle, and other The radiographic and clinical variables would be valuable.
An extended follow-up beyond three months would clarify the trajectory of functional improvement during definitively establish causation from this observational the critical rehabilitation period.
Comparison of these it remains possible that the association between findings with outcomes from other geographic regions radiographic parameters and functional outcomes would determine whether the population-specific cut- off values identified here are truly region-specific or unmeasured variables such as the severity of initial investigation of the relationship between specific surgical techniques .
ateral versus medial osteotomy.
The inclusion of cases with highly different fixation method.
and achievement of target variable surgical delays .
Ae720 day.
may introduce Additionally.
Functional severity and other factors related to chronicity.
assessment using more sophisticated instruments Furthermore, the study did not formally assess other such as objective range of motion measurements and radiographic parameters such as change in carrying patient-reported outcome measures, would provide angle or presence of coronoid fractures, which may more granular data than the categorical Flynn criteria influence outcomes.
Long-term functional follow-up beyond three months was not available, limiting our In conclusion, this study demonstrates that ability to assess the trajectory of functional recovery.
restoration of normal Baumann's angle and shaft- The condylar angle .
sing a population-specific cut-off value of 41.
80A) is strongly associated with satisfactory First, functional outcomes following surgical treatment of These evidence-based radiographic parameters during osteotomy.
Second, support for making restoration of these radiographic they support the use of population-specific cut-off parameters a priority during operative planning and values rather than applying universal reference ranges While cosmetic outcomes are uniformly derived from acute fracture studies.
Third, they highlight that while cosmetic outcomes are generally underscoring the need for continued attention to excellent with modern surgical techniques, functional technical precision and careful patient selection during the perioperative period.
The results emphasize continued attention to technical precision during the the clinical utility of radiographic assessment in operative procedure.
Finally, the study provides evidence-based justification for the time and effort outcomes in this challenging subset of pediatric invested in careful preoperative planning and precise orthopedic injuries.
Long-term follow-up is essential to determine whether the functional outcomes assessed at three months represent stable or improving trajectories.
relationship between radiographic parameters and Some functional outcomes.
Stratified analysis by age groups progressive rehabilitation and remodeling through or duration of malunion may reveal differential effects adolescence, while others may experience a plateau or across subgroups.
deterioration due to developing stiffness or post- The study provides valuable data regarding the traumatic arthritis.
Serial assessment at 6, 12, and 24 prevalence of normal and abnormal radiographic months would clarify the functional trajectory and identify patients at risk for poor long-term outcomes.
achieved normal Baumann's angle in 67.
9% of cases Additionally, assessment of pain, quality of life, and and normal shaft-condylar angle in 60.
7% of cases.
participation in activities would provide patient- These success rates reflect the technical challenges centered outcome data complementing the objective inherent in correcting severe malunion, particularly These when the fracture has healed with bony bridging and comprehensive outcome measures would more fully soft tissue contracture.
The fact that we could achieve characterize the clinical significance of achieving normal parameters in approximately two-thirds of post-operatively.
severely abnormal values present preoperatively, yet The surgical technique employed in this cohortAi K-wire fixationAirepresents leaves room for improvement in operative technique intraoperative imaging modalities to enhance the However.
The regression toward the mean phenomenon alternative approaches, including medial osteotomy, should be considered in the interpretation of the posterior osteotomy, and hybrid techniques, exist, and it remains unclear whether the relationships observed identified in this study.
The optimal cut-off values between radiographic parameters and outcomes would .
40A for Baumann's angle, 41.
80A for the shaft- condylar angl.
were derived from the same dataset used for analysis, which may result in overfitting and may not generalize to other populations.
External validation in an independent cohort is essential before Comparative parameters would advance the field significantly.
precision of surgical restoration.
cut-off recommending these specific cut-off values for clinical Patient factors may influence both radiographic application in other settings.
The wide confidence outcomes and functional results in ways that were not intervals observed, particularly for the shaft-condylar fully captured in this analysis.
Age at surgery, angle, emphasize the importance of interpreting these estimates with appropriate caution and recognizing the limitations of small-sample statistics.
engagement, and socioeconomic status influencing The disparity between cosmetic and functional access to rehabilitation services may all affect outcomes observed in this cohort merits careful functional trajectories.
Additionally, the study did not The achievement of 100% cosmetic systematically assess changes in carrying angle, which satisfaction despite only 64.
3% functional satisfaction represents a key cosmetic parameter in the Flynn indicates that anatomical restoration at the level of Future studies incorporating multivariable gross alignment does not guarantee optimal functional analysis and adjustment for potential confounders This likely reflects the complexity of the would strengthen causal inference regarding the elbow joint, which depends not only on gross geometric alignment but also on precise articular Conclusion surface congruity, ligamentous integrity, soft tissue Normal management of neglected supracondylar humerus supracondylar osteotomy primarily corrects varus fractures in children is strongly and significantly angular deformity but may not fully address all three- associated with satisfactory functional outcomes.
The population-specific shaft-condylar angle cut-off value abnormalities present in severely neglected cases.
80A also demonstrated a significant association Future studies incorporating computed tomography with functional results.
Both parameters warrant imaging and advanced biomechanical analysis may careful consideration as surgical targets during identify additional factors beyond the two-dimensional operative planning and execution.
While cosmetic The Baumann's surgical techniques, functional outcomes remain The timing of surgery relative to injury may represent an important confounding or mediating radiographic parameters may represent an important variable that deserves further investigation.
In acute modifiable factor to optimize functional results.
Larger supracondylar humerus fractures, early reduction prospective multicenter studies are recommended to within 24 hours is associated with better outcomes.
validate these findings and determine whether similar However, in neglected cases, the relationship between relationships exist across different populations and surgical delay and outcome may be different.
Some geographic regions.
These data provide evidence-based studies suggest that prolonged delay allows early consolidation of malunion to soften, potentially neglected supracondylar humerus fractures.
prolonged immobilization results in irreversible soft Our The radiographic parameters assessed in this investigationAiBaumann's angle and shaft-condylar outcomes correlate with radiographic restoration angleAirepresent rather than surgical delay suggests that the quality of measurements that can guide operative decision- anatomical restoration, rather than timing alone, making and facilitate communication among members determines functional results.
of the surgical team.
By establishing the relationship The receiver operating characteristic analysis between these parameters and functional outcomes in provides additional context for understanding the neglected supracondylar humerus fractures, this prognostic value of these radiographic parameters.
study provides a foundation for future prospective The area under the curve represents the probability studies and establishes evidence-based targets for that a patient with satisfactory functional outcomes surgical restoration.
The findings emphasize the has a higher value on the test parameter than a patient importance of intraoperative imaging and meticulous with unsatisfactory outcomes.
The moderate area under curve values .
578Ae0.
suggest that while trajectory of children treated for this challenging these parameters are informative, they should not be orthopedic problem.
As pediatric orthopedic surgery considered in isolation.
A comprehensive clinical technology and surgical instrumentation, maintaining patient age, surgical timing, soft tissue status, and focus on anatomical restoration as a means to rehabilitation potential provides the most robust functional improvement remains paramount.
Future approach to outcome prediction.
innovations should be evaluated not merely on their ultimately on their ability to improve functional supracondylar fractures of the humerus.
outcomes and quality of life for affected children and Bone Joint Surg Am.
: 263Ae72.
Kitta
MI,
Mitra
AK,
Supracondylar
References