Baumann's Angle and Shaft-Condylar Angle as Predictors of Functional Outcome After Surgery for Neglected Supracondylar Humerus Fractures in Children

Introduction: Neglected supracondylar humerus fractures in children remain a significant source of functional impairment, particularly in developing countries. Radiographic parameters such as Baumann's angle and shaft-condylar angle have been proposed as indicators of fracture alignment, yet their association with functional outcomes after surgical intervention has not been systematically evaluated in neglected cases within Southeast Asian populations. Methods: This cross-sectional observational analytic study examined medical records of 28 children treated surgically for neglected supracondylar humerus fractures at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia. Radiographic measurements of Baumann's angle and shaft-condylar angle were obtained preoperatively and at three months postoperatively. Functional outcomes were assessed using the Flynn criteria. Receiver operating characteristic curve analysis with the Youden index determined optimal cut-off values. Results: Mean age was 9.04 ± 3.0 years, with male predominance (75%) and left-sided involvement (71.4%). Mean surgical delay was 188.4 ± 166.3 days. Postoperatively, 100% achieved satisfactory cosmetic outcomes, while functional satisfaction occurred in 64.3% of patients. Normal Baumann's angle was associated with satisfactory functional outcomes (odds ratio 18.667, 95% confidence interval 2.533–137.587, p=0.003). The shaft-condylar angle with population-specific cut-off of 41.80° demonstrated a significant association (odds ratio 11.333, 95% confidence interval 1.048–122.549, p=0.041). Absolute risk difference for Baumann's angle was 62.0%, and for the shaft-condylar angle, the cut-off was 53.9%. Conclusion: Normal Baumann's angle was strongly associated with satisfactory functional outcomes following surgical management of neglected supracondylar humerus fractures. A population-specific shaft-condylar angle cut-off of 41.80° showed a significant association with functional outcomes. Both parameters warrant consideration during operative planning, with multivariate confirmation recommended in larger prospective studies.