Upper Limb TraumaFracture obliquity is a predictor for loss of reduction in supracondylar humeral fractures in older childrenSegal, Davida,,b; Cobb, Leaha; Little, Kevin JaAuthor Information aDivision of Orthopaedic Surgery, Cincinnati Children’s Hospital Medical Center, Affiliated with Cincinnati University, Cincinnati, Ohio, USA bDepartment of Orthopaedic Surgery, Meir Medical Center, Affiliated with Tel Aviv University, Kfar Saba, Israel Correspondence to David Segal, MD, Orthopaedic Surgery Division, Cincinnati Children’s Medical Center, 3333 Burnet Avenue, Cincinnati, 45229 OH, USA Tel: + 1 513 387 9545; fax: + 1 747 1746 9972; e-mail: email@example.com Journal of Pediatric Orthopaedics B: March 2020 - Volume 29 - Issue 2 - p 105-116 doi: 10.1097/BPB.0000000000000636 Buy Metrics Abstract Supracondylar humeral fractures in older children have different biomechanical characteristics and surgical outcomes when compared to the same fractures in younger children. We aimed to analyze the fracture’s architecture in a large group of older children and investigate the correlation between patients’ variables, fracture patterns, fixation techniques and the rate of loss of reduction (LOR). A retrospective review study was conducted. We collected the records of 240 consecutive patients aged 8–14 years that sustained Gartland type 2/3 supracondylar humeral fractures between 2004 and 2014 and were operated at our hospital. We excluded patients with intra-articular or pathological fractures. Following the radiographical analysis and chart review, we conducted a multivariable regression analysis. Fracture obliquity on the sagittal plane ( > 20°) occurred in 33% of the cases and was found to be the only factor related to LOR (P = 0.01). Gartland type 3 fractures and more than two lateral pin configuration did not correlate to fixation failure (P = 0.69 and 0.14, respectively). The incidence of flexion-type fractures (5.8%) was found to be higher than in the total pediatric population. The sagittal oblique supracondylar humeral fracture is common and is related to fixation instability and LOR. This pattern needs to be considered when investigating different pin configurations, complication rates, and biomechanical properties. Subclassifying Gartland type 2/3 supracondylar humeral fractures as ‘oblique’ or ‘transverse’ might offer more comprehensive information about the anticipated operative results, lead to applying more stable pin constructs to these fractures and allow improved outcomes following surgical fixation. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.