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Pain during office removal of K-wires from the elbow in children
Scott M Sorenson1, William Hennrikus
1Department of Orthopaedic Surgery, Penn State College of Medicine, Hershey, PA.
Insights
K-wire removal for pediatric elbow fractures is safe and well-tolerated in an office setting. Most children experienced minimal pain, with no complications reported during the procedure.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Pain Management
Background:
- Closed reduction and K-wire fixation is a standard treatment for displaced supracondylar fractures in children.
- Assessing pain during K-wire removal is crucial for patient comfort and procedural acceptance.
Purpose of the Study:
- To evaluate pain experienced by children during K-wire removal from the distal humerus in an office setting.
- To compare pain assessments using two validated pediatric pain scales: the Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) and the Wong-Baker FACES scale.
Main Methods:
- A retrospective analysis of 47 patients (98 K-wires) who underwent K-wire removal for displaced supracondylar elbow fractures.
- Pain was measured immediately post-removal using the CHEOPS scale (0-13) and the Wong-Baker FACES scale (0-5).
- Correlation between pain scores, patient age, and the number of K-wires removed was analyzed.
Main Results:
- The average patient age was 7.1 years. 64% of patients reported low pain (CHEOPS ≤6) and 37% reported low pain (FACES ≤1).
- Average CHEOPS score was 6; average FACES score was 2. Higher pain scores correlated with younger age and more K-wires removed.
- No severe pain was reported on the CHEOPS scale, and only one patient reported severe pain on the FACES scale.
Conclusions:
- K-wire removal in an office setting is a common and safe practice for pediatric supracondylar fractures.
- The majority of children experienced minimal to no pain during K-wire removal, as indicated by both CHEOPS and FACES scales.
- The procedure is well-tolerated, with no reported complications, supporting its acceptability in an outpatient setting.
Background:
Closed reduction and K-wire fixation is standard treatment for displaced supracondylar fractures in children. The purpose of this study is to evaluate pain using 2 pediatric pain scales when removing K-wires from the distal humerus in children in the office setting.
Methods:
A total of 98 percutaneous smooth K-wires were removed from 47 patients who had sustained displaced supracondylar fractures of the elbow. Pain was measured using the Children's Hospital of Eastern Ontario Pain Scale (CHEOPS). The maximum score is 13 and the minimum score is 4 points. In addition, after K-wire removal, each child indicated on a numbered pain-face diagram (Wong-Baker FACES: a scale consisting of faces with varying emotional expressions and corresponding numbers on a scale from 0 to 5) the amount of pain that they felt.
Results:
The average age of the patients treated was 7.1 years (range, 2 to 14 y). There were 28 males and 19 females. Thirty patients (64%) had a CHEOPS score of ≤6. The average CHEOPS was 6 (range, 4 to 10). Seventeen patients (37%) had a FACES score of ≤1. The average FACES score was 2 (range, 1 to 5). Higher CHEOPS and FACES scores correlated with younger patient age and higher number of K-wires removed.
Conclusions:
K-wire removal in the clinic is common practice. The pain associated with K-wire removal and the safety of this practice has received minimal previous study in the literature. In the present manuscript, 64% of patients had little or no pain measured by the CHEOPS scale--score of ≤6 and 36% had little or no pain self-reported by the FACES scale--score of ≤1. No patient reported severe pain by the CHEOPS scores (CHEOPS 11 to 13) and only 1 patient reported having severe pain with a FACES of 5. No complications occurred. The results of this study suggest that the removal of K-wires in the office setting is safe and acceptable.
Level Of Evidence:
Retrospective analysis.
