Level III-therapeutic.

III, therapeutic study.

PurposeRadiographs are usually taken on day of pin removal for children treated with closed reduction and percutaneous pinning (CRPP) of type 2 supracondylar humerus fractures. The purpose of this study was to determine whether radiographs taken at time of pin removal for patients recovering uneventfully alter management.MethodsAfter IRB approval, billing records identified 1213 patients aged 1–10 years who underwent elbow surgery between 2007 and 2013 at our institution for a supracondylar humerus fracture. Of these patients, 389 met inclusion criteria. Clinical charts were reviewed for demographics, operative details, and clinical follow-up, focusing on clinical symptoms present at pin removal. Radiographs taken at time of pin removal and subsequent visits were assessed for healing and fracture alignment.ResultsIn no case was pin removal delayed based on radiographs. One hundred and nineteen (31 %) patients had radiographs taken following pin removal; in no case was loss of reduction found among these patients. No cases of neurologic or vascular injury, re-fracture, or loss of reduction occurred. Infection occurred in 12 patients (3 %). Pins were kept in place for 23.8 ± 4.4 days. Eighty-six patients (22 %) had additional intervention after pin removal (cast application in all cases). Of 389 patients, 75 (19 %) had no documented reason for extended casting, four (1 %) were extended based on physician evaluation of radiographs, and seven (2 %) were extended for other reasons.ConclusionsElimination of radiographs at time of pin removal should be considered. If continuing to obtain radiographs at pin removal, we recommend removing pins before taking radiographs to reduce patient fear and anxiety from visualizing percutaneous pins.

Level II-diagnostic study.

to manage EOS is associated with frequent complications. The purpose of this study was to determine whether surgeon experience over time results in a decreased frequency of complications related to repetitive surgeries. Methods: This was a retrospective review of an institutional review boardeapproved prospective database of 915 consecutive Vertical Expandable Prosthetic Titanium Rib surgeries, including initial implants, expansion, and exchanges by a single surgeon between 2003 and 2012. Population demographics and complications were collected. Statistical analysis including Pearson correlation was conducted to examine the association between the rate of complication and the number of surgeries performed. Results: Ninety-five patients underwent 915 surgeries during the study period. Average age was 7.7 years (range, 0e17 years). There was an average of 11.5 surgeries/patient (range, 2e25 surgeries/patient). A total of 173 complications were reported, with a mean of 2.35/patient. Sixteen patients had no complications whereas most patients had 1 to 2 complications; 1 patient had 15. The rate of complications did not increase with increasing numbers of surgeries (r 5 0.028; p 5 .831). Ninety-six complications were classified as disease-related and 77 were device-related. The overall rate of total complications remained steady at approximately 20%/year. Device-related complications alone remained steady at 8.6%/ year despite increasing experience of the surgeon. Conclusions: Complications are a relatively common and expected event in managing EOS using growth-friendly instrumentation. Despite increasing surgeon experience with Vertical Expandable Prosthetic Titanium Rib expansion and exchange surgeries, the rate of complications remained consistent over a 9-year period. This may reflect the complexity of this patient population more than the experience of the surgeon.