Radiographic considerations for pediatric supracondylar humerus fractures

Although supracondylar humerus fractures are common pediatric injuries, guidelines for postoperative imaging remain unclear. This study's purpose was to evaluate decision-making at various points in the postoperative period. The secondary objective was to compare the use of mini C arm fluoroscopy and flat plate X-rays at the first postoperative visit. A retrospective, cohort study was performed at one level I trauma center. Patients ages 1 to 14 with extension Gartland type II-IV supracondylar fractures sustained between January 2013 and May 2020 and treated with closed or open reduction and percutaneous fixation were included. Data collected included demographics, fracture characteristics, and imaging information. Of 553 patients who underwent surgery, 375 (67.8%) received intraoperative images after casting; none resulted in an intraoperative intervention. Of 463 patients with imaging at first follow-up, nine (1.9%) had a management modification, including seven for loss of reduction, all determined by the original operating surgeon. The method of imaging, did not differ significantly with respect to revision surgery. Twenty-six (4.0%) of 532 patients with imaging at pin removal received additional casting after pin removal, but no patients had their pins retained. This retrospective study examined the efficacy of imaging in pediatric supracondylar fractures. Intraoperative, postcasting images did not change management and should be discontinued. Imaging at first follow-up can be useful in identifying patients with loss of reduction and mini C arm serves as a viable alternative to standard X-rays. Finally, imaging at pin removal resulted in additional casting only in type III fractures. Level of evidence: Level III-retrospective, cohort study.