Postoperative Baumann's and Shaft-Condylar Angles and Three-Month Functional Outcome after Corrective Surgery for Neglected Pediatric Supracondylar Humerus Fractures

Abstract

Background: Neglected pediatric supracondylar humerus fractures, still common in developing countries, heal with a multiplanar deformity that can limit elbow function. Baumann's angle and the shaft-condylar angle guide surgical realignment, but how they relate to functional recovery after reconstruction is unclear, particularly in Southeast Asian children.

Objective: To evaluate how the postoperative Baumann's and shaft-condylar angles relate to three-month function after surgery for these fractures.

Methods: This retrospective cross-sectional study included 28 children aged 4–15 years treated surgically at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia. Angles measured three months after surgery were related to Flynn outcomes with Fisher's exact test, receiver operating characteristic (ROC) analysis, and exploratory penalized logistic regression.

Results: Mean age was 9.04 ± 3.00 years; 75.0% of the children were boys and 71.4% of fractures were left-sided. The median surgical delay was 120.0 days (range 24–720; mean 188.4 ± 166.3). All 28 children (100.0%) had a satisfactory Flynn cosmetic result, but only 18 (64.3%) had a satisfactory functional result. A normal Baumann's angle (64°–81°; 67.9%) was associated with satisfactory function (odds ratio [OR] = 18.667, 95% confidence interval [CI]: 2.533–137.587, p = 0.003; absolute risk difference [ARD] = 62.0%), as was a shaft-condylar angle below the ROC-derived cutoff of 41.80° (OR = 11.333, 95% CI: 1.048–122.549, p = 0.041; ARD = 53.9%).

Conclusion: After surgery for neglected pediatric supracondylar humerus fractures, a Baumann's angle within 64°–81° and a shaft-condylar angle below 41.80° were associated with satisfactory three-month function. The sagittal cutoff was derived in this cohort and needs external validation.