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Routine evaluation of supracondylar humerus fracture percutaneous pin sites does not decrease complications: a
Alexis Aboulafia1, Brendan Grant1, Rohini M Vanodia1
1University of Texas Health Science Center at Houston, Houston, USA.
Insights
Routine pin site evaluation after pediatric supracondylar humerus fracture surgery does not improve outcomes. Early pin site checks are unnecessary unless a clinical indication exists, simplifying postoperative care for supracondylar humerus fractures.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Trauma Surgery
Background:
- Supracondylar humerus fractures are the most common pediatric elbow fractures requiring surgery.
- Current practices vary regarding early postoperative pin site evaluation.
- Limited comparative studies exist on the necessity of routine pin site assessment.
Purpose of the Study:
- To determine if routine examination of surgical pin sites at the first postoperative visit impacts complication rates or outcomes.
- To compare outcomes between routine pin site evaluation, no early evaluation, and evaluation based on clinical indication.
Main Methods:
- Retrospective cohort study of 355 pediatric patients surgically treated for supracondylar humerus fractures (2011-2017).
- Data extracted included fracture type, surgical treatment, postoperative course, and complications.
- Patients categorized into routine pin evaluation, no early evaluation, or clinical indication groups.
Main Results:
- No loss of reduction occurred in the routine or no early evaluation groups.
- Three patients (8.82%) in the clinical indication group returned to the OR for loss of reduction.
- No significant differences in healing outcomes or complications were found between routine and non-routine early evaluation groups.
Conclusions:
- Routine pin site evaluation after pediatric supracondylar humerus fracture surgery does not reduce complications or improve outcomes.
- Postoperative care can continue until pin removal without early pin site assessment, unless clinically indicated.
- Simplifying postoperative follow-up protocols is feasible without compromising patient safety.
Background:
Supracondylar humerus (SCH) fractures are the most common type of pediatric elbow fractures that require surgical intervention. Studies suggest limiting the first postoperative visit to the time of pin removal or limiting radiographs at first postoperative follow-up may not increase complication rates, but few comparative studies exist. This study aims to determine if routinely examining surgical pins sites at the first postoperative visits affects the complication rates or outcomes compared to only evaluating pin sites if a clinical indication exists.
Methods:
This cohort study retrospectively reviewed patients who were surgically treated for a supracondylar humerus fracture at a Pediatric Level 1 Trauma Hospital from 2011-2017. Clinical records and surgical reports were reviewed, and data was extracted to determine fracture type, surgical treatment, and postoperative course. Complications were recorded.
Results:
Three hundred and fifty-five patients were included; 138 patients had a routine pin evaluation at first postoperative visit, 183 had no pin evaluation until time of pin removal, and 34 had a clinical indication for pin site evaluation at the initial postoperative visit. No patients in the routine pin evaluation or the no early pin evaluation group had a loss of reduction. In the clinical indication group, three patients returned to the operating room (8.82%) due to a loss of reduction, as determined by radiographs. No significant differences were found in healing outcomes or complications between the group that had a routine evaluation versus the group that did not.
Conclusion:
Routine pin site evaluation in the initial postoperative setting after closed or open reduction and pinning of supracondylar humerus fractures without clinical indication does not lead to fewer complication, return to operating room, or improved outcomes. The initial dressing and immobilization can be continued until pin removal unless clinical/radiographic indication to evaluate pin sites exists.
Level Of Evidence:
Level III.
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