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Objectives and questions: Supracondylar fractures of the humerus are the most common paediatric elbow fractures, with Gartland Type III fractures posing significant challenges due to a higher likelihood of closed reduction failure. Identifying predictive factors for failure can aid in appropriate counselling of the patient and parents, better surgical planning and improving patient outcomes.

Material and methods: This descriptive cross-sectional study was conducted over 12 months at a level I tertiary care centre and university based academic institution. 50 children with closed Gartland Type III supracondylar fractures of humerus without neurovascular deficit and presenting within 7 days of injury were enrolled. Demographic, clinical and radiographic variables were analysed, including age, Body Mass Index (BMI), injury-to-reduction time, fracture displacement and presence of gross swelling. All cases initially underwent closed reduction and percutaneous pinning (CRPP) with Kirschner wire (K-wire) in elective basis under general anaesthesia. Open reduction and internal fixation (ORIF) was performed for failed closed reductions. Bivariate analyses were performed to determine the significant risk factors for failure of closed reduction while multivariate logistic regression was done to find the strength of prediction (Odds ratio) for those variables.

Results: Overall, closed reduction was successful in 64% of cases, while 36% required ORIF. The bivariate analysis identified high BMI, displacement >4 mm, swelling, and delayed injury-to-reduction time as significant risk factors for CRPP failure. Multivariate logistic regression revealed that an injury-to-reduction time beyond three days was the most predictive factor for CRPP failure (aOR: 11.08, 95% CI: 1.69–7.27) followed by time of presentation (OR: 10.36, 95% CI: 0.51–20.93) and presence of swelling (OR: 4.68, 95% CI: 0.67–7.74).

Discussion and conclusions: Delay in injury-to-reduction time, high BMI, and greater displacement significantly increase the risk of closed reduction failure in Gartland Type III supracondylar fractures. Early surgical intervention and careful preoperative evaluation of risk factors are essential to improve outcomes by proper counselling and planning of surgery.