Objective: In this study,we aimed to evaluate the effect of surgical treatment timing of Gartland extension type III humeral fractures on functional and cosmetic outcomes, in the pediatric age group and to compare them with literature.

Methods: Between November 2015 and October 2018, files of patients who were admitted to the emergency orthopedics department with Gartlantd extension type III supracondylar humeral fractures and who underwent surgery were investigated. Fifty cases under the age of 15 years were included in the study. These patients were divided into two groups (early and late groups) by examining time before surgery. At outpatient follow up, functional and cosmetic results were evaluated using Flynn criteria at the 12th postoperative week.

Results: Fifty patients (58% males and 42% females) with an average age of 79.7 months (range=15-164 months) were included in the study. All of the patients had closed fractures. Surgical open reduction rate was 30% (n=15), with 20% (n=5) in the early group and 40% (n=10) in the late group. Patients were evaluated according to Flynn criteria at the 12th week of outpatient follow up. In the early group, 92% (n=23) and 8% (n=2) of patients had excellent and good cosmetic results, respectively; 64% (n=16), 28% (n=7), 4% (n=1), and 4% (n=1) had excellent, good, moderate, and poor functional results, respectively. When the outpatient clinic records of the late group patients were examined, 88% (n=22) and 12% (n=3) had excellent and good cosmetic results, respctively, and 52% (n=13), 24% (n=3), 16% (n=4), and 8% (n=2) had excellent, good, moderate, and poor functional results, respectively. No significant difference was found between the two groups in terms of cosmetic and functional results (p=0.641 and p=0.260, respectively). However, it was observed that patients operated with a closed method had better functional outcome than those treated by open surgery (p<0.001).

Conclusion: There was no significant difference between the early and late groups in terms of cosmetic and functional durations of the cases. However, we identified that early surgical treatment reduces operative time, C-arm fluoroscopy usage, hospitalization, and open surgery ratio. We propose that Gartland type III supracondylar humeral fractures should be treated with closed surgical methods within the first 12 hours considering the negative effect of open reduction on functional outcomes.