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Objectives and questions: Supracondylar humerus fractures are among the most common elbow injuries in children. Treatment strategies primarily depend on the von Laer classification; however, clinical outcomes may also be influenced by factors such as timing of presentation, surgical intervention, and postoperative management. This retrospective bicentric study compares treatment approaches, organizational aspects, and clinical outcomes in two European pediatric trauma centers, one in Germany and the other in Greece.

Material and methods: This retrospective bicentric observational study included patients aged 0–16 years with radiologically confirmed supracondylar humerus fractures treated at two European pediatric trauma centers in Germany and Greece between January 2020 and December 2024. Intraarticular or pathological fractures, polytrauma cases, revision procedures, incomplete records, and missing initial radiographs were excluded. Collected data comprised demographics, time of presentation, admission-to-surgery interval, von Laer classification, treatment modality, implant removal, complications, and elbow range of motion at 6 weeks and 3 months. Radiographic alignment was assessed using the carrying angle and Baumann’s angle. Ethical approval was obtained from the ethical review board.

Results: A total of 310 patients were included, 66 from a German university hospital and 244 from a Greek pediatric hospital. A significantly more liberal surgical indication for von Laer type II fractures was observed in the German center, whereas a more conservative approach predominated in the Greek center. Despite differing treatment thresholds, functional outcomes at 6 weeks and 3 months were comparable between centers. Implant removal was performed earlier in Greece, typically after 4 weeks, without the need for general anesthesia, as Kirschner wires were left protruding. In contrast, implant removal in Germany occurred after approximately 6 weeks and routinely required a second general anesthesia. Complication rates, including infection, secondary displacement, nerve injury, and malalignment, did not differ significantly between centers.

Discussion and conclusions: This study demonstrates that differing surgical indications and postoperative management strategies for pediatric supracondylar humerus fractures, particularly von Laer type II, can yield comparable short-term functional outcomes. Earlier implant removal without additional anesthesia represents a potential advantage in terms of patient burden and resource utilization. These findings support the need for standardized, evidence-based treatment algorithms and further prospective multicenter studies.