The Utility of the Early Postoperative Follow-up and Radiographs After Operative Treatment of Supracondylar Humerus Fractures in Children

• Published in: Journal of pediatric orthopaedics Vol. 40; no. 5; pp. 218 - 222
• Main Authors: Acosta, Anna M., Li, Yi-Ju, Bompadre, Viviana, Mortimer, Alex, Trask, Michael, Steinman, Suzanne E.
• Format: Journal Article
• Language: English
• Published: United States Wolters Kluwer Health, Inc. All rights reserved 01-05-2020; Copyright Wolters Kluwer Health, Inc. All rights reserved
• Subjects: Aftercare; Bone Nails; Casts, Surgical; Child; Child, Preschool; Closed Fracture Reduction - adverse effects; Closed Fracture Reduction - instrumentation; Female; Humans; Humeral Fractures - diagnostic imaging; Humeral Fractures - surgery; Male; Postoperative Complications - etiology; Postoperative Period; Radiography; Retrospective Studies; Time Factors; Time-to-Treatment; Treatment Outcome
• ISSN: 0271-6798; 1539-2570
• DOI: 10.1097/BPO.0000000000001432

BACKGROUND:Supracondylar humerus (SCH) fractures are common elbow injuries in pediatric patients. The American Academy of Orthopedic Surgeons published guidelines for the standard of care in the treatment of displaced SCH fractures, however, no recommendations for follow-up care were made. With the recent push to eliminate unnecessary radiographs and decrease health care costs, many are questioning postoperative protocols. The purpose of our study was to evaluate the utility of the 1-week follow-up appointment after closed reduction and percutaneous pinning (CRPP) of displaced SCH fractures.
METHODS:A retrospective review performed at a single institution from 2014 to 2016 included patients under 14 years of age with a closed, displaced SCH fracture treated with CRPP. Exclusion criteria included patients without complete clinical or radiographic follow-up. Variables examined included time to initial follow-up, change in treatment plan after 1-week x-rays, complications, demographics, fracture type, pin number and configuration, reduction parameters, immobilization, time to pin removal, duration of casting, and clinical outcome.
RESULTS:A total of 412 patients were divided into 2 groups based on time to initial follow-up. Overall, 368 had an initial follow-up at 7 to 10 days (group 1) and 44 at 21 to 28 days (group 2). There was no difference in age, sex, fracture type, pin configuration, or a number of pins between groups. Statistically significant findings included time to initial follow-up and days to pin removal (group 1 at 26.2 d vs. group 2 at 23.8 d), type of immobilization (group 1 with 5% circumferential casts and group 2 with 70%), and time to surgery (26.2 vs. 62.9 h, respectively). There was no significant difference in complication rates and only a 0.5% rate of change in management in group 1.
CONCLUSIONS:Early postoperative follow-up and radiographs did not change the patient outcome and might be eliminated in children with displaced SCH fractures treated with CRPP. Given the current focus of on efficiency and cost-effective care, eliminating the 1-week postoperative appointment would improve appointment availability and decrease medical cost.
LEVEL OF EVIDENCE:Level III—Therapeutic.