Omitting the Early Postoperative Follow-up in Uncomplicated Operative Supracondylar Humerus Fractures in Children Does Not Negatively Affect Outcomes

Abstract

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.

Radiological and Clinical Outcomes of Pediatric Patients With a Supracondylar Humerus Fracture Surgically Treated With Closed Reduction and Percutaneous Pinning

“…In our study, the average humerocapitellar angle of all patients on the operated side was 41.97 ± 3.08 degrees. It is similar to the result in the study of 1,518 cases conducted by Boden et al [18].…”

Postoperative Immobilization Period for Pediatric Supracondylar Fractures: The Shorter the Better?

“…16 The majority of recent papers on postoperative management of these fractures have focused on the questionable necessity of early follow-up (eg, at 1 week) and the value of follow-up after pin removal. [16][17][18][19][20][21] In all such papers, the average pin removal date was never longer than 28 days postoperatively in any group, and therefore despite a lack of robust literature evidence, this appears to be a widely used time period. Rutarama et al 22 showed good functional outcomes in a prospective cohort of 38 children with Gartland type III supracondylar fractures who were all immobilized for 3 weeks post reduction and K-wires, but there was no comparator group.…”

“…Some have suggested the lack of utility in bringing these children back for a 1 week check-up in uncomplicated cases but this has certainly not been applied in most centers, including those patients seen in the current study. 17,20 In comparing the effects of immobilization length on the outcome, the current paper, therefore, represents the first of its kind. Though it was not statistically significant, there was nearly a 4-week difference between the groups for the length of time followed up.…”

“…The majority of recent papers on postoperative management of these fractures have focused on the questionable necessity of early follow-up (eg, at 1 week) and the value of follow-up after pin removal 16–21 . In all such papers, the average pin removal date was never longer than 28 days postoperatively in any group, and therefore despite a lack of robust literature evidence, this appears to be a widely used time period.…”