Objective:

To develop and externally validate a preoperative decision-support model predicting failed closed reduction in pediatric supracondylar humerus fractures, thereby enhancing surgical planning.

Key Findings:

• 34.1% of patients required conversion to open reduction.
• Final model retained predictors: displacement direction, preoperative Baumann angle, and medial spike/entrapment sign.
• Model showed good discrimination (AUC = 0.842) in development cohort and acceptable discrimination (AUC = 0.727) in validation cohort, indicating its potential utility in clinical settings.
• Calibration demonstrated good agreement between predicted and observed risks.

Interpretation:

The developed model may assist in preoperative planning and improve surgical efficiency by identifying patients at risk of failed closed reduction, potentially leading to better patient outcomes.

Limitations:

• Retrospective design limits generalizability; further prospective validation is required before clinical implementation.
• Study conducted in a limited regional cohort, necessitating broader validation to confirm findings.

Conclusion:

A practical decision-support model for predicting failed closed reduction in pediatric SCHF has been developed and validated, potentially enhancing surgical planning and patient safety.