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Streamlining Postoperative Care After Pediatric Supracondylar Humerus Fractures: Is Follow-up After Pin Removal
Harshadkumar A Patel1, Sonia Chaudhry, Mark C Lee
1Department of Orthopedic Surgery, University of Connecticut, Connecticut Children's Medical Center, Hartford, CT.
Insights
Routine follow-up visits after pin removal for uncomplicated supracondylar humerus fractures (SCHFs) can be safely eliminated. This streamlines care without increasing clinical events, benefiting patients and healthcare efficiency.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
Background:
- Closed reduction and percutaneous pinning is standard for displaced supracondylar humerus fractures (SCHFs).
- Limited literature exists on optimal postoperative management protocols for SCHFs.
- Current practices often include routine follow-up visits after pin removal.
Purpose of the Study:
- To evaluate the necessity of routine after-pin removal (APR) follow-up visits in uncomplicated SCHFs.
- To determine if eliminating routine APR visits impacts patient outcomes or clinical events.
- To identify strategies for streamlining postoperative care for SCHFs.
Main Methods:
- Retrospective review of 179 patients with SCHFs treated with closed reduction and percutaneous pinning.
- Comparison of two cohorts: routine follow-up (FU) versus non-follow-up (NFU) after pin removal.
- Analysis of demographics, surgical variables, complications, and clinical events up to 3 months post-pin removal.
Main Results:
- No significant differences in complications or clinical events between FU and NFU groups.
- The FU group incurred an average of 1.98 additional X-rays post-pin removal.
- No patients in the NFU group required physical therapy referrals.
Conclusions:
- Routine APR follow-up visits are not necessary for uncomplicated SCHFs managed operatively.
- Eliminating routine APR visits can streamline postoperative care without compromising patient outcomes.
- Patient education on expectations, activity, and home exercises is crucial for successful non-follow-up care.
Background:
Closed reduction and percutaneous pinning is the standard of care for displaced supracondylar humerus fractures (SCHFs). Although the operative management of SCHFs has achieved good consensus with low complication rates, there remains a paucity of literature on postoperative management. We hypothesized that routine office visits after pin removal can safely be avoided in uncomplicated SCHFs without compromising patient care.
Method:
A retrospective review was conducted to query the electronic medical record for SCHFs, treated with closed reduction and percutaneous pinning. Patients with complicated SCHFs were excluded. Patients were divided into 2 cohorts: follow-up (FU) and nonfollow-up (NFU), depending on the presence or absence of after-pin removal (APR) FU visits. Demographics, surgical variables, number of x-rays, referrals for physical therapy, total FU visits, complications, and clinical events after pin removal up to 3 months were compared. Subgroup analysis was performed according to Gartland fracture types.
Results:
A total of 179 patients were included in the study, 111 in the FU group and 68 in the NFU group. There were no significant differences found in demographics between the 2 groups. There were no significant differences in complications and APR clinical events between 2 groups (P>0.05). An average of 1.98 additional x-rays were taken APR in FU group. None of the NFU group patients required physical therapy. Excluding patients with pin site infections, 15/108 (13.9%) of FU group patients had >1 APR visits.
Summary:
For operatively managed uncomplicated SCHFs, patients who do not have routinely scheduled FU APR have no greater incidence of clinical events APR than patients with a scheduled FU. With a detailed discussion including expectations, timeframe for resuming activities, home exercises, and reassurance of the ease of FU if desired, routine FU APR can be safely eliminated after uncomplicated SCHFs in order to streamline postoperative care.
Level Of Evidence:
Level III.
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