Does the fracture line position relative to the olecranon fossa affect surgical difficulty and outcomes in pediatric supracondylar humerus fractures?

BACKGROUND: This study aimed to investigate whether the level of the fracture line relative to the olecranon fossa influences surgical difficulty, complication rates, and radiological outcomes in pediatric supracondylar humerus fractures (PHSF). METHODS: A retrospective review was conducted of 822 children who underwent surgical treatment for PHSF. Patients were categorized according to the location of the fracture line relative to the apex of the olecranon fossa: high-level (proximal to the fossa, n=163) and low-level (at or distal to the fossa, n=659). High-level fractures were further classified as oblique (n=40) or transverse (n=123), based on the angle between the fracture line and the transepicondylar line. Patient demographics, fracture characteristics, surgical parameters, complications, radiographic findings, and revision rates were analyzed. RESULTS: There were no significant differences between groups in terms of patient demographics, fracture side, open versus closed fracture status, neurovascular injury, or associated trauma (p>0.1). High-level fractures were significantly more unstable, required longer surgical durations, and showed a greater number of K-wire cortical scars compared to low-level fractures (p