Delayed Revision Closed Reduction and Percutaneous Pinning of a Pediatric Supracondylar Humerus Fracture: A Case Report.

Supracondylar humerus fractures (SCH) are the most prevalent elbow fractures in the pediatric age group. Delay in treatment poses challenges and an elevated risk of complications. We describe a case of revision for postoperative malalignment with closed reduction percutaneous pinning with good clinical outcomes. Malunion complications in SCH can be minimized with early intervention in cases of postoperative displacement. Careful use of technical skills can help with closed reduction in cases with delayed presentation.

Surgical Challenges and Outcomes in Treating a Floating Upper Arm With Multiple Humerus Fractures and Radial Neck Fractures.

Complex humerus fractures associated with high-energy trauma present significant surgical challenges due to their impact on limb functionality and structural integrity. This case report details the treatment of a floating upper arm injury, characterized by multiple humerus fractures and a radial neck fracture, in a 50-year-old male following a vehicular accident. The patient exhibited fractures at the proximal, mid-shaft, and distal segments of the humerus, necessitating an integrated surgical approach to effectively manage these injuries. Dual surgical approaches and perpendicular plating were employed to address the multifaceted nature of the fractures. The patient achieved satisfactory functional recovery, regaining a significant range of motion, which highlights the efficacy of the chosen surgical strategy. This case contributes to the existing literature by illustrating the benefits of specific surgical techniques in managing complex humerus fractures, emphasizing the necessity for meticulous planning and execution to optimize patient outcomes.

Management of Pediatric Elbow Fractures and Dislocations.

Pediatric elbow fractures and dislocations have always been a challenge from a diagnostic and therapeutic point of view, primarily due to the complex nature of the pediatric elbow, especially its developmental anatomy. They must be diagnosed and treated on time to prevent numerous complications with long-term consequences. With the development of radiology and pediatric surgery and orthopedics, as well as the development of modern osteosynthesis materials, concerning current scientific and professional knowledge, the outcomes are getting better, with fewer acute and chronic complications. This comprehensive review aims to provide clinicians current knowledge about pediatric elbow fractures and dislocations so that in daily practice they have as few doubts as possible with the best possible treatment outcomes.

[Trauma-associated vascular injuries and the vascular surgical/interventional options for vascular reconstruction]. / Traumaassoziierte Gefäßverletzungen und deren gefäßchirurgische/interventionelle Rekonstruktionsmöglichkeiten.

AIM: The aim of this work is to illustrate the diversity of vascular injuries in terms of vascular segments or body regions, accident mechanisms and specific patient constellations. METHOD: A representative case collection was compiled based on current and relevant scientific references in PubMed, own clinical experiences, vascular surgical and novel image-guided interventional options. RESULTS: The diagnostics of vascular injuries in the context of trauma and fractures are based on a thorough physical examination. In addition, the hard and soft signs preferred by the Western Trauma Association should be included in the decision. Doppler ultrasonography examination is the safest and gentlest noninvasive examination procedure for a suspected vascular injury due to repeatable and comparative measurements. The stabilization of a fracture, ideally using an external fixator, should be performed before vascular reconstruction whenever possible, unless massive bleeding, hypovolemic shock or a rapidly spreading hematoma represent an immediate indication for surgery. In pediatric supracondylar fractures, avascular injury without relevant ischemia has frequently been described (pink pulseless hand). In this case, the fracture should first be reduced as the pulse often recovers. Due to the increasing availability, good technical handling and high technical success rate as well as the relatively limited interventional trauma, endovascular treatment of traumatic vascular injuries has become widely accepted. Traumatic aortic ruptures are associated with a high mortality even at the accident site. Rapid endovascular treatment using a stent prosthesis significantly increases the injured person's chances of survival. CONCLUSION: Vascular injuries in connection with fractures or multiple injuries require interdisciplinary cooperation between the specialties involved.

A Systemic Review of Adolescent Supracondylar Fractures: What Is the Surgical Treatment, Open Reduction With Internal Fixation (ORIF) or Closed Reduction With Percutaneous Pinning (CRPP)?

Supracondylar humerus (SCH) fractures represent the most frequent elbow injury in young children. These fractures can be treated through either closed reduction with percutaneous pinning (CRPP) or open reduction with internal fixation (ORIF). Yet, the optimal treatment option for adolescents remains unclear. This research contrasts the results of CRPP and ORIF treatments for distal humerus fractures in adolescents. In June 2023, we conducted a comprehensive search of PUBMED, OVID MEDLINE, Web of Science, Cochrane Central Register of Controlled Trials, and various trial registries without any time restrictions. We evaluated the quality of qualifying studies using the Methodological Index for Non-randomized Studies (MINORS) and Cochrane risk measures for bias. We extracted data particularly related to patient demographics, fracture details, medical procedures followed, complications encountered, and the resulting outcomes. Out of the 488 studies identified, only four satisfied the inclusion criteria. Both methods illustrated comparable outcomes in terms of range of motion, averaging approximately 118 degrees in the ORIF group versus a span of 114 to 128 degrees in the CRPP group. The immobilization period varied, spanning 10 to 13 days for ORIF versus 24 to 29 days for CRPP. Despite this, CRPP displayed a decreased necessity for additional surgery. Notably, one study indicated a higher frequency of heterotopic ossification within the ORIF group. This review indicates that both CRPP and ORIF are effective for treating supracondylar fractures in adolescents, yielding similar results. However, CRPP has a lower need for follow-up surgery. Future studies with larger sample sizes are needed to solidify these findings, providing stronger guidance for treatment.

The effects of postoperative malrotation alignment on outcomes of Gartland type III/IV paediatric supracondylar humeral fractures treated by close reduction and percutaneous K-wire fixation.

PURPOSE: In this study, we aimed to investigate the effects of postoperative malrotation alignment on the outcomes of Gartland type III/IV paediatric supracondylar humeral fracture (SCHF) treated by close reduction and percutaneous K-wire fixation. METHODS: Between January 2014 and December 2021, 295 Gartland type III/IV paediatric SCHFs treated by close reduction and percutaneous K-wire fixation were selected for this retrospective study. The demographic, clinical and radiographic parameters of all cases were collected. The lateral rotation percentage (LRP) was measured on X-rays to evaluate postoperative malrotation alignment of the fracture. All cases were categorized into 4 groups according to LRP: LRP ≤ 10% (210, 71.2%), 10% < LRP ≤ 20% (41, 13.9%), 20% < LRP ≤ 30% (26, 8.8%) and LRP > 30% (18, 6.1%). The carrying angle, ranges of multidirectional motions, Mayo Elbow Performance Score (MEPS) and Flynn's Standard Score (FSS) of the injured elbow were assessed 6 months postoperation and compared among different groups. ROC analysis based on LRP and the excellent/good rate of FSS was performed to determine the acceptable maximum degree of postoperative malrotation alignment. RESULTS: There was no difference in the demographic characteristics (age, sex, injured side and fracture type), postoperative Baumann angle, carrying angle or range of forearm rotation among the 4 groups (P > 0.05). The operation time and time from operation to K-wire removal were longer in the 20% < LRP ≤ 30% and LRP > 30% groups than in the LRP < 10% and 10% < LRP ≤ 20% groups (P < 0.001). The shaft condylar angle, range of elbow flexion, MEPS and FSS of the injured elbow 6 months postoperatively were lower in the 20% < LRP ≤ 30% and LRP > 30% groups than in the LRP < 10% and 10% < LRP ≤ 20% groups (P < 0.001). ROC analysis based on LRP and the excellent/good rate of FSS showed an area under the curve of 0.959 (95% CI 0.936-0.983), with a cutoff value of 26.5%, sensitivity of 95.3% and specificity of 90.1%. CONCLUSION: A certain degree of residual malrotation alignment deformity of the SCHF may reduce the shaft condylar angle and extend the time from operation to removing the K-wire and affect elbow function, especially the range of elbow flexion. The acceptable maximum degree of residual malrotation deformity expressed as the LRP value was 26.5%.

Management of Open Supracondylar Humeral Fracture in Children: A Case Report and Literature Review.

Open supracondylar humeral fractures (SHFs) are rare, and there have been few papers specifically addressing their management. In this report, we describe the management and 27-month outcomes of an open SHF. A healthy eight-year-old boy presented with open SHF of the right elbow and underwent percutaneous lateral fixation using two Kirschner wires (K-wire) after irrigation and debridement (I&D) through an anterior approach. Excellent outcomes were obtained without any complications over a 27-month follow-up period. The management of open SHFs in children is yet to be standardized; nevertheless, we believe that I&D is a crucial step, that well-done lateral entry K-wires could provide the required stability, that the anterior approach is logical, safe, and effective, and that the high healing potential of children is our ally in such injuries.

Radiological and Clinical Outcomes of Pediatric Patients With a Supracondylar Humerus Fracture Surgically Treated With Closed Reduction and Percutaneous Pinning.

OBJECTIVES: It was aimed to evaluate the clinical and radiological results of patients operated on with closed reduction and pinning due to pediatric supracondylar humerus fractures. MATERIALS AND METHODS: The radiological and clinical results of 100 patients operated on with closed reduction and percutaneous pinning for pediatric supracondylar humerus fractures in the Department of Orthopedics and Traumatology were examined between January 2015 and February 2022. Clinical results were evaluated by performing cosmetic and functional scores defined by Flynn. Closed reduction and percutaneous pinning techniques were used in surgical treatment. RESULTS: In our study, 59 patients were male (59%), and 41 were female (41%). The average age of all patients is 6.21 ± 2.85 years. According to the Gartland classification, 21 patients' fractures were type IIA (21%), 12 patients' fractures were type IIB (12%), 51 patients' fractures were type III (51%), and 16 patients' fractures were type IV (16%). The average number of pins used in the treatment is 2.55 ± 0.50. The elbow bearing angle of the operated side of the patients was an average of 6.53 ± 3.29 degrees, the humerocapitellar angle was an average of 41.97 ± 3.08 degrees, and the lateral humerocapitellar angle was an average of 50.17 ± 3.58 degrees. Fifty-one patients had stage 0 (51%), 23 patients had stage 1 (23%), 23 patients had stage 2 (23%), and three patients had stage 3 (3%) residual sagittal plane deformity. According to the Flynn criteria, 92 patients had excellent functional results (92%), seven patients had good results (7%), and one patient had fair results (1%). Regarding cosmetic results, 91 patients had excellent results (91%), six patients had good results (6%), and three patients had fair results (3%). CONCLUSION: Supracondylar humerus fractures are common in children and can cause serious complications. Closed reduction and percutaneous pinning techniques are effective treatment methods in the treatment of displaced supracondylar humerus fractures.

Management of Pediatric Humeral Supracondylar Fractures in a Referral Center From a Developing Country: A Comparison With American Academy of Orthopaedic Surgeons (AAOS) Guidelines.

Introduction Supracondylar fractures are the predominant type of pediatric elbow fractures. The usual mechanism of injury is falling over the hand with the elbow extended and the hand open. The management of these fractures encompasses a range of treatment options, and their goal is to recover the anatomy and achieve a stable contact area between them. There are some controversies on the management of these injuries mainly focused on those that present some degree of displacement. A review and analysis of the current treatment at our institution and a comparison with the guidelines suggested by the American Academy of Orthopaedic Surgeons (AAOS) for the treatment of these fractures in the pediatric population were performed. Materials and methods This was an observational, analytical, retrospective study of consecutive pediatric patients with displaced supracondylar humeral fracture treated at Hospital de Trauma "Manuel Giagni" in Asunción, Paraguay, from January 2016 to December 2021. Demographic and clinical data were assessed, and patients were clinically and radiologically followed for at least 12 months. The management of supracondylar humeral fractures at our hospital was compared with the guidelines suggested by the American Academy of Orthopaedic Surgeons (AAOS) by analyzing whether these guidelines were applied in each case. The mechanism of injury was divided into three groups, initial X-rays were measured, extension-type fractures were categorized into three groups, and the type of treatment was divided into two groups: non-operative and operative. Furthermore, trauma-related preoperative complications and postoperative complications were reported. Outpatient follow-up was performed for at least 12 months in all cases. Results Of the 843 patients analyzed, 71.5% were male, with a mean age of 5.6 years. It was observed that 57.5% of injuries were caused by falls on the same level. The most frequent type of injury was Gartland type III, accounting for 55% of the cases, and associated injuries were found in 4% of the cases. With regard to the type of treatment, 91.8% of patients were treated with closed reduction and percutaneous pin fixation. Complications on admission were found in 12% of the cases and late complications in 12% of the cases. Most patients (82%) had excellent Mayo Elbow Performance Score. Conclusion Supracondylar fractures were more frequent in males and in schoolchildren. Garland type III fractures were the most common type of injury. The treatment of choice was predominantly closed reduction and percutaneous pin fixation. The Mayo Elbow Performance Score was excellent in most patients. Our service, a referral center of a public hospital in a developing country, complies with the guidelines recommended by the AAOS.

Factors Influencing Functional Outcomes in Supracondylar Humerus Fractures: A Retrospective Study of Paediatric Patients in a Level One Trauma Centre.

Background The outcomes after fixation of the supracondylar humerus fracture (SCHF) are not documented in the current literature. In our study, we endeavour to determine the factors that influence the functional outcome and gauge their respective impact. Methodology We retrospectively reviewed the outcomes of patients who presented to our tertiary care centre (Royal London Hospital) with SCHFs between September 2017 and February 2018. We analysed patient records to assess several clinical parameters, including age, Gartland's classification, comorbidities, time to treatment, and fixation configuration. We conducted a multiple linear regression analysis to determine each of the clinical parameter's impact on the functional and cosmetic outcome, as reflected in Flynn's criteria. Results We included 112 patients in our study. Pediatric SCHFs had good functional outcomes based on Flynn's criteria. There was no significant statistical difference in functional outcomes with respect to sex (p= 0.713), age (p= 0.96), fracture type (p= 0.14), K-wire configuration (p=0.83), and time elapsed since surgery (p= 0.240). Conclusions Our results demonstrate that good functional outcomes can be expected with paediatric SCHFs based on Flynn's criteria, regardless of age at injury, sex, or pin configuration, provided satisfactory reduction is achieved and maintained. The only variable with statistical significance was Gartland's grade; Grades III and IV were correlated with poorer outcomes.

Beneficial Perioperative Aspects Favor the Use of Percutaneous Crossed Pinning over Antegrade Nailing in Pediatric Supracondylar Fractures-A Retrospective Comparative Study.

(1) Background: Displaced supracondylar humeral fractures in pediatric patients can be treated by either antegrade nailing (AN) or percutaneous crossed pinning (PCP). The aim of this study was to compare the intra- and perioperative management, complications and outcome of AN and PCP. (2) Methods: This retrospective study enrolled 271 individuals (median age 5 years, IQR 4-7 years) who underwent AN (n = 173) or PCP (n = 98). Patient history was analyzed for incidence of nerve injuries, postoperative treatment, postoperative malrotation, time of hospital stay, time to implant removal and revision rate. Operative procedures were investigated for duration and radiation exposure. (3) Results: PCP was associated with a significantly lower radiation exposure (dose area product: PCP mean 20.1 cGycm2 vs. AN mean 34.7 cGycm2, p < 0.001; fluoroscopy time: PCP mean 1.1 min, range 0.1-8.1 min, vs. AN mean 1.5 min, range 0.1-7.1 min, p < 0.001), duration of surgery (PCP mean 32.2 min vs. AN mean 48.3 min, p < 0.001) and time to implant removal (PCP mean 37 days vs. AN mean 113 days, p < 0.001). Cast removal was performed earlier in the AN group (PCP mean 30.2 days vs. AN mean 20.4 days, p < 0.001) and there were fewer iatrogenic nerve lesions (PCP: 24% vs. AN: 8%, p < 0.001). (4) Conclusions: In the investigated study population, the analyzed parameters seem to favor the use of PCP. The advantages of AN should be weighed against its drawbacks. For special indications, AN remains a relevant technique in supracondylar fracture treatment, and surgeons should be familiar with this procedure.

Clinical and radiographic outcomes after paediatric supracondylar humeral fractures treated with combined intramedullary and lateral wire fixation: our experience in fifty-one cases.

PURPOSE: Displaced supracondylar humerus fractures in children are known for their high rate of complications and require urgent surgical treatment. Basically, there are two methods of fracture fixation: the lateral pin technique and the crossed pin technique. However, the best technique remains debated. The aim of this study was to evaluate the clinical and radiographic outcomes of our method of fixation using combined intramedullary and lateral wires for treatment of displaced supracondylar humeral fractures in paediatric patients. METHOD: Fifty-one paediatric patients were treated for displaced supracondylar humeral fractures. The method of fracture fixation used consists of two Kirschner wires inserted one intramedullary and the other laterally. Clinical and radiographic outcomes were assessed at last follow-up. RESULTS: According to Gartland's classification, 17 fractures (33%) were type 2 and 34 (67%) were type 3. The mean follow-up period was 7.8 months. Functional outcome according to Flynn's criteria was satisfactory in all cases with 92% graded as excellent or good. Cosmetic outcome according to Flynn's criteria was satisfactory in all cases. Radiologically, at last follow-up, the mean Baumann angle was 69° (63-82°) and the mean lateral capitellohumeral angle was 41° (32-50°). CONCLUSION: Patients managed with combined intramedullary and lateral wires experience satisfactory results. Moreover, this technique, without risk for the ulnar nerve, can be interesting in the treatment of infrafossal fractures and fractures with anterior displacement.

Extra Lateral Pin or Less Radiation? A Comparison of Two Different Pin Configurations in the Treatment of Supracondylar Humerus Fracture.

BACKGROUND: Closed reduction and percutaneous fixation are the most commonly used methods in the surgical treatment of supracondylar humerus fractures. The pin configuration changes stability and is still controversial. The aim of this study was to investigate the relationship between surgical duration and radiation dose/duration for different pinning fixations. METHODS: A total of 48 patients with Gartland type 2, 3, and 4 supracondylar fractures of the humerus were randomized into two groups-2 lateral and 1 medial (2L1M) pin fixation (n = 26) and 1 lateral 1 medial (1L1M) pin fixation (n = 22). A primary assessment was performed regarding surgical duration, radiation duration, and radiation dose. A secondary assessment included clinical outcome, passive range of motion, radiographic measurements, Flynn's criteria, and complications. RESULTS: There were 26 patients in the first group (2L1M) and 22 patients in the second group (1L1M). There was no statistical difference between the groups regarding age, sex, type of fracture, or Flynn's criteria. The overall mean surgical duration with 1L1M fixation (30.59 ± 8.72) was statistically lower (p = 0.001) when compared to the 2L1M Kirschner wire K-wire fixation (40.61 ± 8.25). The mean radiation duration was 0.76 ± 0.33 s in the 1L1M K-wire fixation and 1.68 ± 0.55 s in the 2L1M K-wire fixation. The mean radiation dose of the 2L1M K-wire fixation (2.45 ± 1.15 mGy) was higher than that of the 1L1M K-wire fixation (0.55 ± 0.43 mGy) (p = 0.000). CONCLUSIONS: The current study shows that although there is no difference between the clinical and radiological outcomes, radiation dose exposure is significantly lower for the 1L1M fixation method.

Small incision reduction and external fixation for the treatment of delayed over fourteen days supracondylar humeral fractures in children.

Background: Supracondylar humeral fractures (SHF) are the most common type of fracture occurring at the distal humerus in children. In patients with delayed presentation of SHF, closed reduction is challenging to achieve with traditional reduction maneuvers. This study aimed to report the clinical results of pediatric SHF delayed over 14 days treated by closed reduction with a minimally invasive technique and external fixation and evaluate the efficacy of this technique. Methods: Between October 2010 and September 2018, children with delayed presentation of SHF over 14 days were retrospectively included in this study. The patients received closed reduction with a minimally invasive technique followed by external fixation. The demographics and radiographic data were collected. The Mayo Elbow Performance Score (MEPS) and the Flynn criteria were used to evaluate the clinical outcomes of treatments. Results: A total of 11 children (aged 4-13 years) with delayed presentation (range, 14-22 days) were recruited. They received surgery using closed reduction with a minimally invasive technique followed by external fixation. None of the surgery was done with the open method. After surgery, the patients' carrying angle returned to normal. The radiological union was evident in 8 to 12 weeks in all fractures without complications. Every patient had a good to excellent score on the MEPS and the Flynn criteria. Conclusions: The results of this series indicated a satisfactory outcome in children with delayed more than 14 days of supracondylar humeral fractures. The closed reduction with a minimally invasive technique followed by external fixation is an alternative treatment for such injury.

Pediatric Floating Elbow Caused by a Novel Mechanism: A Case Report.

A pediatric floating elbow is a rare condition in which there is a humeral supracondylar fracture with an ipsilateral fracture of one or both bones of the forearm. We report a case caused by an unusual mechanism of a semi-automatic washing machine. This injury, on its own, involves the risk of compartment syndrome, however, this particular child came late. We present our approach to this challenging injury along with the controversial management in the literature.

Comparison of Lateral and Crossed K-wires for Paediatric Supracondylar Fractures: A Retrospective Cohort Study.

Background Supracondylar elbow fractures occur most frequently in children aged five to seven years and have equal incidence in both genders. They are classified as flexion or extension type injuries with extension type being more common. We aimed to ascertain radiological stability with lateral and crossed wires in this study. We also identified any complications after operative management of these injuries. Methods As part of this retrospective cohort study, we identified all patients who presented with this injury from January 1, 2020, until February 28, 2022. Basic demographic data and type of operation were noted. Baumann angle (BA) and lateral capitellohumeral angle (LCHA) were measured intra-operatively and x-rays were done at the final clinic appointment. The mean of these angles in lateral and crossed wire groups was compared using paired sample t-test. Unpaired t-test was used to compare the means of both groups with normal values for these angles based on previous studies (BA=71.5±6.2 degrees, LCHA= 50.8±6 degrees). Results Fifty patients were admitted during this period. Thirty-three patients had lateral wires and 17 had crossed wires for fixation. No significant change was noted in the mean BA and mean LCHA in both groups on x-rays done intra-operatively and final clinic follow-up (no loss of reduction). No significant difference was noted between BA and LCHA noted for both groups at the final clinic follow-up with previous studies outlining normal values for these angles. No cases of iatrogenic neurovascular injury were identified. Four patients (8%) were referred to physiotherapy due to stiffness. Conclusion Both lateral and crossed wire configurations led to achievement of good radiological stability with BA and LCHA within normal limits. No loss of reduction was noted with both techniques and no risk of iatrogenic nerve injuries was noted in experienced hands.

Standalone Axial Malrotation after Pediatric Supracondylar Fracture Does Not Seem to Be an Indication for Immediate Postoperative Revision Surgery.

Rotational spurs as evidence for post-surgical malrotation are frequently observed when treating pediatric supracondylar humeral fractures (SCHFs). This study aimed to investigate the long-term outcome of a pediatric cohort with unrevised axial malrotation and to discuss the indication for revision surgery. Postoperative radiographs of children treated for SCHFs over eight years were retrospectively analyzed. Children with radiological signs of malrotation (von Laer malrotation quotient) were invited for a follow-up clinical and radiological examination. Among 338 treated children, 39 (11.5%) with a mean age of 5.3 years (range 1.8-11.7 years) showed radiological signs for postoperative malrotation and were not revised and therefore invited to participate in the study. Twelve patients (31%) with a mean age of 11.3 years (range 8.8-13.8 years) took part in the follow-up examination after a mean of 7.1 years (range 5.4 to 11.3 years). The mean postoperative van Laer malrotation quotient was 0.15 (range 0.11-0.2). At follow-up, the range of motion of the elbow joint was not significantly different compared to the contralateral side. Apart from the humeral ulnar angle (p = 0.023), there were no significant differences in the radiological axes. The Flynn criteria were excellent and good in 90% of the cases. The mean was 1.7 points indicating excellent subjective results. Standalone postoperative malrotation did not lead to an adverse long-term outcome in a small cohort of pediatric patients with SCHFs and did not indicate immediate postoperative revision surgery. However, further investigations with larger cohorts should verify whether additional criteria such as stability of the osteosynthesis and signs for increasing valgus or varus displacement in the follow-up radiographs should get more importance in decision making.

Treatment and outcomes of pediatric supracondylar humeral fractures in Korle Bu Teaching Hospital.

OBJECTIVES: Supracondylar humeral fractures (SCHF) are the most common elbow injury in the pediatric population. The treatment, outcome, and health-related quality of life (HRQoL) following these injuries are described. METHODS: Patients with SCHF who were treated depending on the fracture type were evaluated. Medical records stored in the REDCap database were reviewed to obtain information on demographics, mechanisms of injury, neurovascular status, infection rates, and postoperative complications. Outcomes were assessed using Flynn's criteria and Pediatric Quality of Life (PedsQL) version 4.0. Follow-up was for 6 months. RESULTS: A total of 101 patients with a mean age of 5.2 years (SD ±â€Š2.3) were seen. Most of the injuries occurred at home (64.3%). The left-arm (nondominant) was the most injured (62%), though 92% of patients were right hand dominant. Ninety-six percent of the fractures were the extension type. A total of 98% had satisfactory outcomes using Flynn's criteria and older patients were likely to sustain Gartland type III SCHF (P = .01). There was a significant difference in mean scores of PedsQL (all P values < .01) at 6 months. CONCLUSIONS: In this prospective study, the quality of life of patients following SCHF diminished at the time of the injury and returned to the population normal 6 months after. There was no significant difference in HRQoL scores between patients who presented early and those who presented late. The delayed presentation and management did not also affect the functional outcome and complications. Therefore, surgical management of these injuries after late presentation is still safe.