title: Predictors of failure of nonoperative treatment for type-2 supracondylar humerus fractures.
abstract: BACKGROUND
  Closed reduction and casting for type-2 supracondylar fractures is a viable treatment option, but studies have shown that some patients will fail to maintain the initial reduction in a cast. This study sought to identify predictors of failed treatment of closed reduction and casting for these fractures.
  
  
  METHODS
  We performed a retrospective case-control study of type-2 supracondylar fractures treated by closed reduction and casting. Using radiographic failure of reduction as our primary outcome measure, we examined injury, postreduction, and follow-up films evaluating the anterior humeral line, cast flexion angle, and degree of cast padding in an attempt to identify predictors of failure.
  
  
  RESULTS
  We reviewed 645 fractures. Of 126 type-2 fractures, 61 fractures were included in the study. There were 49 (80%) nonoperative treatment successes and 12 failures (20%) with an average follow-up of 41 days (range, 20 to 161 d). We found that (1) the degree of fracture extension using an index based on the anterior humeral line on the injury film was significantly related to failure of cast treatment (P=<0.01), and (2) the width of the soft tissue shadow of the upper arm on the postreduction film was of borderline significance (P=0.02). Cast flexion angle and cast padding were not predictive of radiographic loss of reduction (P=0.94 and 0.70).
  
  
  CONCLUSIONS
  Despite adequate reduction and casting of type-2 supracondylar fractures, some fractures will lose reduction and require delayed pinning. The degree of extension of the distal fragment at the time of injury may help to predict the likelihood of failure of nonoperative treatment.
authors.affiliation: Department of Orthopaedics, Dudley St, Providence, RI 02903, USA. pgfitzgibbons@gmail.com
authors.forename: Peter G
authors.initials: PG
authors.lastname: Fitzgibbons
authors.forename: Ben
authors.initials: B
authors.lastname: Bruce
authors.forename: Christopher
authors.initials: C
authors.lastname: Got
authors.forename: Steve
authors.initials: S
authors.lastname: Reinert
authors.forename: Patricia
authors.initials: P
authors.lastname: Solga
authors.forename: Julie
authors.initials: J
authors.lastname: Katarincic
authors.forename: Craig
authors.initials: C
authors.lastname: Eberson
mesh_terms: D000293:Adolescent; D016022:Case-Control Studies; D002370:Casts, Surgical; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D005592:Fracture Fixation / Q000379:methods*; D006801:Humans; D006810:Humeral Fractures / Q000000981:diagnostic imaging / Q000628:therapy*; D007223:Infant; D008297:Male; D011859:Radiography; D012189:Retrospective Studies; D017211:Treatment Failure; D016896:Treatment Outcome