{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T18:13:06Z","timestamp":1778523186275,"version":"3.51.4"},"reference-count":32,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2026,5,10]],"date-time":"2026-05-10T00:00:00Z","timestamp":1778371200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Gartland Type III supracondylar humerus fractures (SCHFs) represent the most surgically challenging pediatric elbow injuries, yet controversy persists regarding whether the timing of surgery, specifically after-hours versus working-hours operations, influences clinical and radiological outcomes. This study aimed to compare the functional, cosmetic, and radiological outcomes of Gartland Type III SCHFs managed during working hours versus after hours, with a secondary analysis incorporating the surgical approach (open vs. closed reduction). Methods: A retrospective cohort study was conducted, including 91 pediatric patients who underwent surgical treatment for Gartland Type III SCHFs between January 2020 and June 2025. Patients were stratified into working-hours (n = 48) and after-hours (n = 43) groups. Outcomes were assessed using Flynn\u2019s criteria, radiological parameters, range-of-motion measurements, and complication rates. A secondary subgroup analysis was performed across four groups formed by combining surgical timing and approach. Results: The mean patient age was 70.36 \u00b1 32.97 months with a mean follow-up of 28.07 \u00b1 14.66 months. The time to surgery was significantly shorter in the working-hours group (median 16.0 h; IQR 13.5\u201320.0) compared with the after-hours group (median 20.0 h; IQR 17.0\u201327.0) (p = 0.009). No significant differences were observed between the two groups with respect to functional outcomes, cosmetic outcomes, radiological parameters, or overall complication rates (all p &gt; 0.05). However, four-group subgroup analysis revealed a significant difference in Flynn\u2019s functional outcomes (p = 0.019), with the after-hours open reduction subgroup demonstrating a lower rate of excellent results (76.92%) compared with the remaining subgroups (96.88\u2013100%). Conclusions: Working-hours versus after-hours surgical timing alone does not significantly alter clinical or radiological outcomes in Gartland Type III SCHFs. However, the combination of after-hours surgery with open reduction appears to be associated with inferior functional outcomes and a trend toward higher complication rates, suggesting that open reduction for complex fractures should preferably be performed during working hours when optimal theatre conditions and experienced senior surgical teams are readily available.<\/jats:p>","DOI":"10.3390\/jcm15103673","type":"journal-article","created":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T17:17:42Z","timestamp":1778519862000},"page":"3673","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Surgical Timing and Approach in Gartland Type III Supracondylar Humerus Fractures in Children: Does After-Hours Surgery Influence Clinical and Radiological Outcomes? A Retrospective Cohort Study"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4702-6008","authenticated-orcid":false,"given":"Erkan","family":"Servet","sequence":"first","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Faculty of Medicine, Gaziantep University, Gaziantep 27310, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-1120-235X","authenticated-orcid":false,"given":"Murat","family":"D\u00fczg\u00fcn","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Faculty of Medicine, Gaziantep University, Gaziantep 27310, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Musa Alperen","family":"Bilgin","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, T.C. Ministry of Health Aksaray Training and Research Hospital, Aksaray 68000, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4942-849X","authenticated-orcid":false,"given":"Cagr\u0131","family":"Karabulut","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, T.C. Ministry of Health Pazarc\u0131k State Hospital, Kahramanmara\u015f 46700, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-1036-6710","authenticated-orcid":false,"given":"Beytullah","family":"Unat","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, School of Medicine, Gaziantep Islam Science and Technology University, Gaziantep 27000, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nevzat","family":"G\u00f6nder","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Faculty of Medicine, Gaziantep University, Gaziantep 27310, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1016\/j.ocl.2007.12.005","article-title":"Pediatric supracondylar fractures and pediatric physeal elbow fractures","volume":"39","author":"Shrader","year":"2008","journal-title":"Orthop. Clin. N. Am."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1097\/BPO.0b013e31817bb860","article-title":"Patterns of pediatric supracondylar humerus fractures","volume":"28","author":"Bahk","year":"2008","journal-title":"J. Pediatr. Orthop."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1097\/01241398-199801000-00008","article-title":"Etiology of supracondylar humerus fractures","volume":"18","author":"Farnsworth","year":"1998","journal-title":"J. Pediatr. Orthop."},{"key":"ref_4","first-page":"357","article-title":"Staying out of trouble: Complications of supracondylar humerus fractures","volume":"68","author":"Joshi","year":"2019","journal-title":"Instr. Course Lect."},{"key":"ref_5","first-page":"145","article-title":"Management of supracondylar fractures of the humerus in children","volume":"109","author":"Gartland","year":"1959","journal-title":"Surg. Gynecol. Obstet."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1121","DOI":"10.2106\/JBJS.G.01354","article-title":"Supracondylar humeral fractures in children","volume":"90","author":"Omid","year":"2008","journal-title":"J. Bone Joint Surg. Am."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1177\/18632521221106379","article-title":"Current trends in the treatment of supracondylar fractures of the humerus in children: Results of a survey of the members of the European Paediatric Orthopaedic Society","volume":"16","author":"Pavone","year":"2022","journal-title":"J. Child. Orthop."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1186\/s13018-018-0806-1","article-title":"A systematic review and meta-analysis of two different managements for supracondylar humeral fractures in children","volume":"13","author":"Lin","year":"2018","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"980","DOI":"10.2106\/JBJS.D.02956","article-title":"Treatment of multidirectionally unstable supracondylar humeral fractures in children. A modified Gartland type-IV fracture","volume":"88","author":"Leitch","year":"2006","journal-title":"J. Bone Joint Surg. Am."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1228","DOI":"10.1302\/0301-620X.90B9.20728","article-title":"Delaying treatment of supracondylar fractures in children: Has the pendulum swung too far?","volume":"90","author":"Ramachandran","year":"2008","journal-title":"J. Bone Joint Surg. Br."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1186\/s13018-021-02638-5","article-title":"Is there an optimal timing for surgical treatment of pediatric supracondylar humerus fractures in the first 24 hours?","volume":"16","author":"Okkaoglu","year":"2021","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1097\/BPO.0000000000002394","article-title":"Does shorter time to treatment of pediatric supracondylar humerus fractures impact clinical outcomes?","volume":"43","author":"Sullivan","year":"2023","journal-title":"J. Pediatr. Orthop."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Terpstra, S.E.S., Burgers, P.T.P.W., van der Heide, H.J.L., and de Witte, P.B. (2022). Pediatric supracondylar humerus fractures: Should we avoid surgery during after-hours?. Children, 9.","DOI":"10.3390\/children9020189"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e215","DOI":"10.1097\/BOT.0000000000001134","article-title":"Pediatric supracondylar humerus fractures: Does after-hours treatment influence outcomes?","volume":"32","author":"Paci","year":"2018","journal-title":"J. Orthop. Trauma"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Familiari, F., Zappia, A., Gasparini, G., Mercurio, M., Tedesco, G., Riccelli, D.A., Perticone, L., Carlisi, G., Testa, G., and Lucenti, L. (2025). Pediatric supracondylar humerus fracture: When should we surgically treat? A case-series. J. Clin. Med., 14.","DOI":"10.3390\/jcm14010237"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1097\/BPB.0b013e3283046530","article-title":"Open reduction via posterior triceps sparing approach in comparison with closed treatment of posteromedial displaced Gartland type III supracondylar humerus fractures","volume":"17","author":"Aktekin","year":"2008","journal-title":"J. Pediatr. Orthop. B"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Hahn, S.G., Schuller, A., Pichler, L., Hohensteiner, A., Sator, T., Bamer, O., Chocholka, B., Jaindl, M., Schwendenwein, E., and Parajuli, B. (2024). Complications and outcomes of surgically treated pediatric supracondylar humerus fractures. Children, 11.","DOI":"10.3390\/children11070791"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"263","DOI":"10.2106\/00004623-197456020-00004","article-title":"Blind pinning of displaced supracondylar fractures of the humerus in children. Sixteen years\u2019 experience with long-term follow-up","volume":"56","author":"Flynn","year":"1974","journal-title":"J. Bone Joint Surg. Am."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"323","DOI":"10.2106\/00004623-200103000-00002","article-title":"The effect of surgical timing on the perioperative complications of treatment of supracondylar humeral fractures in children","volume":"83","author":"Mehlman","year":"2001","journal-title":"J. Bone Joint Surg. Am."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1535","DOI":"10.1302\/0301-620X.100B12.BJJ-2018-0982.R1","article-title":"Early versus delayed surgery for paediatric supracondylar humeral fractures in the absence of vascular compromise","volume":"100-B","author":"Farrow","year":"2018","journal-title":"Bone Joint J."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1097\/BPO.0b013e3181f9fc03","article-title":"The effects of surgical delay on the outcome of pediatric supracondylar humeral fractures","volume":"30","author":"Bales","year":"2010","journal-title":"J. Pediatr. Orthop."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"791","DOI":"10.5312\/wjo.v14.i11.791","article-title":"Time of surgery and surgeon level in supracondylar humerus fractures in pediatric patients: A retrospective study","volume":"14","author":"Albrahim","year":"2023","journal-title":"World J. Orthop."},{"key":"ref_23","first-page":"199","article-title":"Comparison between the lateral and medial approaches in terms of functional and cosmetic results in the surgical treatment of type III supracondylar humeral fractures in children","volume":"39","author":"Eren","year":"2005","journal-title":"Acta Orthop. Traumatol. Turc."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1016\/j.injury.2007.07.016","article-title":"How should one treat iatrogenic ulnar injury after closed reduction and percutaneous pinning of paediatric supracondylar humeral fractures?","volume":"39","author":"Kalenderer","year":"2008","journal-title":"Injury"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1097\/BPB.0b013e328010b684","article-title":"Prevention of ulnar nerve injury during fixation of supracondylar fractures in children by \u2018flexion-extension cross-pinning\u2019 technique","volume":"16","author":"Eidelman","year":"2007","journal-title":"J. Pediatr. Orthop. B"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1097\/01241398-200207000-00004","article-title":"Factors affecting forearm compartment pressures in children with supracondylar fractures of the humerus","volume":"22","author":"Battaglia","year":"2002","journal-title":"J. Pediatr. Orthop."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1097\/01241398-200201000-00004","article-title":"Treatment of completely displaced supracondylar fracture of the humerus in children by cross-fixation with three Kirschner wires","volume":"22","author":"Shim","year":"2002","journal-title":"J. Pediatr. Orthop."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"320","DOI":"10.5435\/JAAOS-20-05-320","article-title":"The treatment of pediatric supracondylar humerus fractures","volume":"20","author":"Howard","year":"2012","journal-title":"J. Am. Acad. Orthop. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1016\/j.jse.2020.09.021","article-title":"Crossed versus lateral K-wire fixation of supracondylar fractures of the humerus in children: A meta-analysis of randomized controlled trials","volume":"30","author":"Carrazzone","year":"2021","journal-title":"J. Shoulder Elb. Surg."},{"key":"ref_30","first-page":"e30911","article-title":"The outcome of placing the medial K-wire first and then the lateral K-wire in treating supracondylar humerus fractures in children treated by closed reduction","volume":"14","author":"Gupta","year":"2022","journal-title":"Cureus"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2287","DOI":"10.1007\/s00264-015-2975-4","article-title":"Supracondylar humeral fractures in children: Current concepts for management and prognosis","volume":"39","author":"Zorrilla","year":"2015","journal-title":"Int. Orthop."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1097\/BPO.0b013e31817445ff","article-title":"The measurements and standardization of humerocondylar angle in children","volume":"28","author":"Simanovsky","year":"2008","journal-title":"J. Pediatr. Orthop."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/10\/3673\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T17:42:20Z","timestamp":1778521340000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/10\/3673"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,10]]},"references-count":32,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["jcm15103673"],"URL":"https:\/\/doi.org\/10.3390\/jcm15103673","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,10]]}}}