Procedural Outcomes of Double Vs. Single Fluoroscopy for Fixing Supracondylar Humerus Fractures in Children: A Case–Control Study



Supracondylar humerus fractures (SHFs) are frequently seen in the pediatric population. The aim of this study was to compare single- and double-fluoroscopy methods for the closed reduction and percutaneous pinning (CRPP) of Gartland type 2 and type 3 SHFs.

Materials and Methods

Forty patients who underwent surgery between March 2016 and April 2018 were evaluated retrospectively. Twenty-one patients (group 1) who received double fluoroscopy and 19 patients (group 2) who had single fluoroscopy were evaluated. The preparation period, surgical duration, radiation exposure time, fracture types, sex distributions, distribution of sides, radiologic results at the third month, cosmetic and functional results, and the incidence of complications were recorded.


The mean age of the patients in group 1 and group 2 was 4.76 and 4.68 years, respectively. The mean preparation time of group 1 was 11.3 min; whereas in group 2, it was 8.7 min (p < 0.01). The mean surgical duration was 31.76 min in group 1, and 40.47 min in group 2 (p < 0.01). The mean radiation exposure time in group 1 and group 2 was 41.19 and 47.36 s, respectively (p = 0.04). There were statistically significant differences between the two groups in terms of the preparation period, surgical duration, and radiation exposure time. Radiation exposure time and surgical duration were significantly shorter in group 1; the preparation period was shorter in group 2.


The double-fluoroscopy technique can significantly reduce surgical duration and radiation exposure time during surgery while treating SHFs of children.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2
Fig. 3


  1. 1.

    Khoshbin, A., Leroux, T., Wasserstein, D., Wolfstadt, J., Law, P. W., Mohamed, N., et al. (2014). The epidemiology of paediatric supracondylar fracture fixation: a population-based study. Injury,45, 701–708.

    Article  PubMed  Google Scholar 

  2. 2.

    Houshian, S., Mehdi, B., & Larsen, M. S. (2001). The epidemiology of elbow fracture in children: analysis of 355 fractures, with special reference to supracondylar humerus fractures. Journal of Orthopaedic Science,6, 312–315.

    Article  PubMed  CAS  Google Scholar 

  3. 3.

    Rang, M., Barkin, M., & Hendrick, E. B. (1983). Elbow. In M. Rang, M. E. Pring, & D. R. Wenger (Eds.), Children’s fractures (3rd ed., p. 152). Philadelphia: Lippincott, Williams & Wilkins.

    Google Scholar 

  4. 4.

    Weiss, D. B., Milewski, M. D., Thompson, S. R., & Stannanard, J. P. (2012). Trauma. In M. D. Miller, S. R. Thompson, & J. A. Hart (Eds.), Review of orthopaedics (6th ed., pp. 791–793). Philadelphia: Elsevier.

    Google Scholar 

  5. 5.

    Gartland, J. J. (1959). Management of supracondylar fractures of the humerus in children. Surgery, Gynecology and Obstetrics,109, 145–154.

    PubMed  CAS  Google Scholar 

  6. 6.

    Boszczyk, B. M., Bierschneider, M., Panzer, S., Panzer, W., Harstall, R., Schmid, K., et al. (2006). Fluoroscopic radiation exposure of the kyphoplasty patient. European Spine Journal,15, 347–355.

    Article  PubMed  Google Scholar 

  7. 7.

    Peng, K. T., Huang, K. C., Chen, M. C., Li, Y. Y., & Hsu, R. W. (2006). Percutaneous placement of iliosacral screws for unstable pelvic ring injuries: comparison between one and two C-arm fluoroscopic techniques. Journal of Trauma,60, 602–608.

    Article  PubMed  Google Scholar 

  8. 8.

    Kara, A., Celik, H., Seker, A., Uzun, M., Sonmez, M. M., & Erdil, M. (2016). Procedural outcomes of double vs. single fluoroscopy for fixing intertrochanteric femur fractures. Archives of Orthopaedic and Trauma Surgery,136, 929–934.

    Article  PubMed  Google Scholar 

  9. 9.

    Fitzgibbons, P. G., Bruce, B., Got, C., Reinert, S., Solga, P., Katarincic, J., et al. (2011). Predictors of failure of nonoperative treatment for type-2 supracondylar humerus fractures. Journal of Pediatric Orthopedics,31, 372–376.

    Article  PubMed  Google Scholar 

  10. 10.

    Abzug, J. M., & Herman, M. J. (2012). Management of supracondylar humerus fractures in children: Current concepts. Journal of American Academy of Orthopaedic Surgeons,20, 69–77.

    Article  Google Scholar 

  11. 11.

    Flynn, J. C., Matthews, J. G., & Benoit, R. L. (1974). Blind pinning of displaced supracondylar fractures of the humerus in children. Sixteen years’ experience with long-term follow-up. Journal of Bone and Joint Surgery. American Volume,56, 263–272.

    Article  CAS  Google Scholar 

  12. 12.

    Kocher, M. S., Kasser, J. R., Waters, P. M., Bae, D., Snyder, B. D., Hresko, M. T., et al. (2007). Lateral entry compared with medial and lateral entry pin fixation for completely displaced supracondylar humeral fractures in children. A randomized clinical trial. Journal of Bone and Joint Surgery. American Volume,89, 706–712.

    Article  Google Scholar 

  13. 13.

    Skaggs, D. L., Hale, J. M., Bassett, J., Kaminsky, C., Kay, R. M., & Tolo, V. T. (2001). Operative treatment of supracondylar fractures of the humerus in children. The consequences of pin placement. Journal of Bone and Joint Surgery. American Volume,83, 735–740.

    Article  CAS  Google Scholar 

  14. 14.

    Topping, R. E., Blanco, J. S., & Davis, T. J. (1995). Clinical evaluation of crossed-pin versus lateral-pin fixation in displaced supracondylar humerus fractures. Journal of Pediatric Orthopedics,15, 435–439.

    Article  CAS  PubMed  Google Scholar 

  15. 15.

    Turgut, A., Aksakal, A. M., Öztürk, A., & Öztaş, S. (2014). A new method to correct rotational malalignment for closed reduction and percutaneous pinning in pediatric supracondylar humeral fractures. Acta Orthopaedica et Traumatologica Turcica,48, 611–614.

    Article  PubMed  Google Scholar 

  16. 16.

    Gupta, R. (1996). Intercondylar fractures of the distal humerus in adults. Injury,27, 569–572.

    Article  CAS  PubMed  Google Scholar 

  17. 17.

    Kundel, K., Braun, W., Wieberneit, J., & Rüter, A. (1996). Intraarticular distal humerus fractures. Factors affecting functional outcome. Clinical Orthopaedics and Related Research,332, 200–208.

    Article  Google Scholar 

  18. 18.

    Papavasiliou, V. A., & Beslikas, T. A. (1986). T-condylar fractures of the distal humeral condyles during childhood: An analysis of six cases. Journal of Pediatric Orthopedics,6, 302–305.

    Article  CAS  PubMed  Google Scholar 

  19. 19.

    Esen, E., Doğramacı, Y., Gültekin, S., Görmeli, G., Yıldırım, A., Kanatlı, U., et al. (2009). Comparison of radiation exposure times in the treatment of pediatric supracondylar humeral fractures with open-closed reduction and internal fixation. Acta Orthopaedica et Traumatologica Turcica,43, 400–405.

    Article  PubMed  Google Scholar 

  20. 20.

    Mahajan, A., Samuel, S., Saran, A. K., Mahajan, M. K., & Mam, M. K. (2015). Occupational radiation exposure from C arm fluoroscopy during common orthopaedic surgical procedures and its prevention. Journal of Clinical and Diagnostic Research,9, 1–4.

    Article  Google Scholar 

  21. 21.

    Mastrangelo, G., Fedeli, U., Fadda, E., Giovanazzi, A., Scoizzato, L., & Saia, B. (2005). Increased cancer risk among surgeons in an orthopaedic hospital. Occupational Medicine (London),55, 498–500.

    Article  Google Scholar 

  22. 22.

    Valone, L. C., Chambers, M., Lattanza, L., & James, M. A. (2016). Breast radiation exposure in female orthopaedic surgeons. Journal of Bone and Joint Surgery. American Volume,98, 1808–1813.

    Article  Google Scholar 

  23. 23.

    Chou, L. B., Chandran, S., Harris, A. H., Tung, J., & Butler, L. M. (2012). Increased breast cancer prevalence among female orthopedic surgeons. Journal of Women’s Health (Larchmt),21, 683–689.

    Article  Google Scholar 

Download references


No financial disclosure was declared by the authors.

Author information




BG: Study design, data collections, data analysis, writing, final corrections. AT: Study design, data collections, data analysis, writing, final corrections. AS: Data analysis, writing. YMD: Study design, data analysis, writing, final corrections. CT: Data collections, data analysis. YSK: Study design, final corrections. All authors approved the final version of paper for submission.

Corresponding author

Correspondence to Burak Gunaydın.

Ethics declarations

Conflict of Interest

The author(s) declare(s) that there is no conflict of interest regarding the publication of this paper. I(we) affirm that I (we) have no financial affiliation (including research funding) or involvement with any commercial organization that has a direct financial interest in any matter included in this manuscript, except as disclosed in an attachment and cited in the manuscript. Any other conflict of interest (i.e., personal associations or involvement as a director, officer, or expert witness) is also disclosed in an attachment. Burak Gunaydin, Ali Turgut, Abdulkadir Sari, Yasar Mahsut Dincel, Cagatay Tekin, Yavuz Selim Kabukcuoglu declare that they have no conflict of interest. The manuscript has been read and approved by all the authors. The manuscript represents honest work. All submissions and previous reports regarded as redundant publication of the same or very similar work. Any such work referred to specifically and referenced in the new paper.

Ethical Standard Statement

This study “Procedural outcomes of double vs. single fluoroscopy for fixing supracondylar humerus fractures in children” has been registered retrospectively by a registration number ChiCTR1900023885. The study was approved by the Local Ethical Committee dated 27/12/2018 and numbered 2018/152/11/02. Informed consent was obtained from all individual participants included in the study.

Informed Consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity can not be guaranteed.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Gunaydın, B., Turgut, A., Sarı, A. et al. Procedural Outcomes of Double Vs. Single Fluoroscopy for Fixing Supracondylar Humerus Fractures in Children: A Case–Control Study. JOIO (2020).

Download citation


  • Supracondylar humerus fracture
  • Percutaneous pinning
  • Closed reduction
  • Double fluoroscopy