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Omitting the Early Postoperative Follow-up in Uncomplicated Operative Supracondylar Humerus Fractures in Children
Stephanie A Boden1, Ahmed M Khedr2, Natalie E Novak1
1Pediatric Orthopaedic Division, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh.
Insights
Early follow-up after pediatric supracondylar humerus (SCH) fracture surgery is often unnecessary. This study found minimal benefit in early visits for uncomplicated fractures, suggesting they may be safely omitted if fixation is stable.
Area of Science:
- Orthopedic Surgery
- Pediatric Traumatology
- Pediatric Orthopedics
Background:
- Supracondylar humerus (SCH) fractures are the most frequent surgically managed elbow injuries in children.
- Debate exists on the necessity of early postoperative follow-up before pin removal to reduce surgical fixation complications.
- Previous studies had small sample sizes, limiting generalizability.
Purpose of the Study:
- To evaluate the necessity of early postoperative follow-up for pediatric SCH fractures.
- To determine if early follow-up impacts complication rates or management changes.
- To assess the utility of routine early follow-up in uncomplicated cases.
Main Methods:
- Retrospective chart review of 1370 pediatric Gartland type II and III SCH fractures (2005-2015).
- Analysis of patient demographics, fracture characteristics, fixation details, follow-up timing, and outcomes.
- Inclusion criteria focused on operative management at a level 1 pediatric trauma center.
Main Results:
- 1196 patients had early follow-up (1-2 weeks), 174 had later follow-up (3-4 weeks).
- Only 8 cases required management changes from early follow-up, mostly cast adjustments.
- Overall complication rates were low for uncomplicated closed SCH fractures.
Conclusions:
- Closed reduction and percutaneous pin fixation yield good outcomes with low complications for pediatric SCH fractures.
- Early postoperative follow-up before pin removal offers minimal benefit in reducing complications.
- Routine early follow-up can be omitted for stable, uncomplicated SCH fractures.
Background:
Supracondylar humerus (SCH) fractures are the most common surgically treated elbow injuries in children. There have been debates regarding if an early postoperative follow-up before pin removal is necessary to decrease the complications related to surgical fixation. To date, studies examining this topic have included smaller sample sizes, limiting the generalizability of their findings.
Methods:
A retrospective chart review of outcomes after operative management of Gartland type II and III SCH fractures at a single level 1 pediatric trauma center between 2005 and 2015 was performed. Patient demographics, fracture characteristics, pin number and configuration, timing of initial follow-up, change in treatment plan after initial follow-up, time to pin removal, initial and final fracture radiographic parameters, and complications were observed via chart review.
Results:
A total of 1518 SCH fractures underwent operative fixation: 755 Gartland type II and 765 type III. Of the 1518 SCH fractures identified, 1370 met inclusion criteria and were included for analysis. Of these, 1196 patients returned for initial follow-up within 1 to 2 weeks of surgery, and 174 patients had their initial follow-up 3 to 4 weeks postoperatively. There were 8 incidences where initial early follow-up resulted in a change of management; however, change in management was limited to cast alteration in 7 of these cases.
Conclusions:
Closed reduction and percutaneous pin fixation of otherwise uncomplicated closed SCH fractures have good outcomes and a very low complication rate at a level 1 pediatric trauma center. Early postoperative follow-up before the pin removal visit provides minimal utility in decreasing complications and may be safely omitted as long as the initial fracture fixation is deemed to be stable.
Level Of Evidence:
Level III.
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