INTEGRATING CASE-BASED LEARNING IN MEDICAL CURRICULUM: A STUDY ON SUPRACONDYLAR HUMERAL FRACTURES IN PEDIATRIC PATIENTS

Abstract

To evaluate the clinical and functional outcomes of children with supracondylar humeral fractures who underwent delayed open reduction and percutaneous pinning (ORPP) more than two weeks post-injury. A retrospective study was conducted at the
Shaheed Mohtarma Benazir Bhutto Institute of Trauma. The study included 56 children aged 6 months to 12 years with Gartland type II and III supracondylar humeral fractures treated with ORPP. Data were collected on demographic characteristics, fracture classification, time to surgery, radiological findings, and functional outcomes. Disabilities of the Arm, Shoulder, and Hand (DASH) scores were
used to assess recovery at 3 months postoperatively, and postoperative complications were documented. The mean time from injury to surgical intervention was 16 days (range: 14–18 days). All fractures achieved radiological union, with 75% of cases uniting by 8 weeks and the remainder by 12 weeks. At 3 months postoperatively, 80% of patients had DASH scores indicating good to excellent functional recovery, with minimal restrictions in activities such as playing, writing, and dressing. The remaining 20% experienced moderate functional limitations, primarily due to soft-tissue stiffness and inconsistent adherence to physiotherapy. Radiographic evaluations confirmed restored alignment and normal carrying angles in all cases, with no significant differences in functional recovery between Gartland type II and III fractures (p> 0.05). Postoperative complications were rare, with only two cases of pin-site infection, both
managed conservatively without long-term sequelae. No major complications, including neurovascular injuries, malunion, or growth disturbances, were observed. Adherence to structured physiotherapy protocols significantly improved range of motion and DASH scores, emphasizing the importance of rehabilitation in optimizing outcomes. Delayed open reduction and percutaneous pinning for pediatric supracondylar humeral fractures provides favorable clinical and radiological outcomes, even when performed beyond the conventional two-week window. This study highlights the viability of ORPP as an effective intervention in resource-constrained
settings, underscoring the critical role of comprehensive postoperative care and physiotherapy in ensuring optimal recovery.