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Pediatric Supracondylar Humerus Fractures: The Utility of Post-Mobilization Follow-Up
Wei Shao Tung1,2, Tamara Muñoz2, Lenice Yue Tong Tan3
1Trauma Service, Department of Orthopaedic Surgery.
Insights
Early discharge after mobilization is feasible for pediatric supracondylar humerus fractures (pSCHFs). Most patients with uncomplicated pSCHFs can be safely discharged early, avoiding unnecessary follow-up visits.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Traumatology
Background:
- Current follow-up protocols for pediatric supracondylar humerus fractures (pSCHFs) lack universal consensus.
- Post-mobilization follow-ups are standard for assessing range of motion and deformities.
- There's a growing trend towards optimizing efficiency by reducing clinic visits for uncomplicated fractures.
Purpose of the Study:
- To examine current follow-up practices for pSCHFs at a multicenter institution.
- To evaluate the utility of post-mobilization follow-up visits.
- To determine criteria for safe early discharge after pSCHF management.
Main Methods:
- Retrospective analysis of pediatric patients with pSCHFs managed between January 2016 and March 2024.
- Stratification based on discharge status and need for post-mobilization follow-up.
- Comparison of patient, injury, and treatment characteristics using statistical tests (χ2, Fisher's exact, Welch's T, Mann-Whitney U).
Main Results:
- 15.4% of 384 patients were discharged early post-mobilization.
- Increased fracture severity and intervention complexity correlated with the need for additional follow-up (P<0.0001).
- Stiffness (72.4%) and nerve palsy (7.9%) were primary reasons for subsequent follow-ups.
Conclusions:
- Early discharge after mobilization for pSCHFs is a feasible but underutilized practice.
- Most patients attending post-mobilization follow-ups had no significant issues and were discharged the same day.
- Uncomplicated pSCHFs (Gartland I-III) may allow early discharge post-mobilization if no immediate complications arise; patient/family education on red flags is crucial.
Introduction:
There is currently no universally accepted follow-up protocol for pediatric supracondylar humerus fractures (pSCHFs), but post-mobilization follow-ups are commonly scheduled to evaluate range of motion and the presence of deformities. Recent practice has trended towards enhancing efficiency by reducing unnecessary clinic visits for uncomplicated fractures. This study examines follow-up practices after pSCHFs at our multicenter institution, evaluating the utility of post-mobilization follow-up visits, and determining appropriate criteria for safe early discharge.
Methods:
All consecutive pediatric patients who underwent definitive management for pSCHFs between January 1, 2016, and March 1, 2024, at our multicenter institution were screened. Patients were stratified and analyzed based on their discharge status and need for additional follow-up post-mobilization. Patient, injury, and treatment characteristics were compared using χ 2 , Fisher's exact, Welch's T, and Mann-Whitney U tests, as appropriate.
Results:
Of the 384 patients included in this analysis, 59 (15.4%) were discharged early after elbow mobilization. Increased fracture severity and intervention complexity were significantly associated with the need for additional follow-up (both P <0.0001). This association was also evident among patients discharged after one post-mobilization follow-up visit (201/277; 72.6%), as compared with those who were not (76/277; 27.4%) ( P <0.0001). Subsequent follow-ups were primarily indicated for stiffness (55/76; 72.4%), followed by nerve palsy (6/76; 7.9%).
Conclusions:
Early discharge of pediatric patients from clinic after fracture healing, cast removal, and mobilization of supracondylar humerus fractures is a feasible, yet underutilized practice. Most patients who returned to clinic after mobilization did not present any concerns of stiffness or loss of function and were discharged during the same visit. Our findings suggest that for patients with uncomplicated fractures (Gartland I-III), early discharge after mobilization may be acceptable if no immediate complications are identified. However, it is crucial to advise patients and their families to seek follow-up care if a significant functional deficit or a change in recovery is observed in the injured arm after discharge. All red flags are discussed with the families during their follow-up visit.
