The Utility of Routine Postoperative Radiographs After Pinning of Pediatric Supracondylar Humerus Fractures

Karalius, Vytas P.; Stanfield, Jacob; Ashley, Philip; Lewallen, Laura; deDeugd, Casey; Walker, Janet L.; Larson, A. Noelle; Milbrandt, Todd A.

doi:10.1097/bpo.0000000000001000

Cited by 24 publications

(29 citation statements)

References 32 publications

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“…Karalius et al 16 evaluated the utility of obtaining early (seven to ten days postoperative) and late (prior to pin pull) radiographs. These authors concluded that early radiographs were of value, as 1.6% of patients had an alteration in management based on these radiographs, including revision surgery, early pin removal and pin adjustment.…”

Section: Discussionmentioning

confidence: 99%

Is less more? Assessing the utility of early clinical and radiographic follow-up for operative supracondylar humerus fractures

Thompson

Hubbard

Elliott

et al. 2018

Journal of Children's Orthopaedics

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Abstract:PurposePostoperative protocols following surgical management of supracondylar humerus fractures (SCFs) are often based upon surgeon preference rather than clinical merit. The purpose of this study is to determine the utility of early clinical and radiographic follow-up.MethodsA retrospective review of patients who underwent closed reduction and percutaneous pinning (CRPP) for SCF between 2009 and 2015 was performed using a database of prospectively-collected consecutive patient data. Previously undiagnosed neuropathies documented at the first postoperative visit were identified. Unscheduled visits and postoperative complications were compared between patients who were seen at one week and those with delayed first clinic visits.ResultsOf 873 patients, 823 (94.3%) were seen within ten days of surgery (early follow-up) and 50 (5.7%) had a delayed first clinic appointment. Among patients seen for early follow-up, 12 (1.5%) had a previously undocumented neuropathy diagnosed but only eight (1%) had an alteration of management secondary to clinical findings. Greater than 90% of patients seen for early follow-up had radiographs performed, but only one had an alteration in management due to radiographic findings. Patients seen for early follow-up had the same rate of unscheduled visits (2.9% versus 4%, p = 0.66) and postoperative complications (1.6% versus 0%, p > 0.99) as those with delayed first appointments. Radiographic parameters were comparable at final follow-up (Baumann’s angle 74.5° versus 73.7°, p = 0.40; lateral humeral condylar angle 40.2° versus 41.2°, p = 0.53).ConclusionThe early follow-up visit after CRPP of SCF rarely leads to alterations in care and does not reduce unscheduled visits or late complications.Level of EvidenceLevel IV

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Section: Discussionmentioning

confidence: 99%

Is less more? Assessing the utility of early clinical and radiographic follow-up for operative supracondylar humerus fractures

Thompson

Hubbard

Elliott

et al. 2018

Journal of Children's Orthopaedics

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“…Our study similarly demonstrated no changes to the management of patients based on follow up radiographs and, while not directly tested given its retrospective design, this questions the value of routine radiographs in the absence of repeat injury or worsening exam findings. One wonders whether these patients can be spared routine monitoring radiographs, similar to a recommendation following pediatric supracondylar humerus fractures ( 14 ).…”

Section: Discussionmentioning

confidence: 99%

Rate of Complications and Subsequent Shoulder Complaints for Non-operatively Managed Pediatric Proximal Humerus Fractures

et al. 2020

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The purpose of the study was to describe the early complications and delayed shoulder complaints of non-displaced or minimally displaced pediatric proximal humerus fractures treated non-operatively. Methods: Retrospective review of all pediatric proximal humerus fractures at a single institution from 2001 to 2016. Inclusion criteria were: AP and axillary radiographs upon presentation and final follow up, one follow up appointment, either a non-displaced or minimally displaced fracture, and open physis. Exclusion criteria were: pathologic fractures, re-fractures, bone metabolic disorders. Patient demographics, injury characteristics, radiographic measurements and clinical exam findings were reviewed. Delayed shoulder complaints were defined as a visit to any provider for an ipsilateral shoulder or arm complaint after final scheduled fracture appointment. Results: Sixty-nine of 177 total pediatric proximal humerus fractures met inclusion criteria. Mean age was 10 years (SD = 3.4). Sixty-five had angulation <20 degrees. Median time to last scheduled follow up was 1.4 months (Interquartile range 0.8-1.4). At last scheduled follow up, 9 (13.0%) fractures had an altered exam. One (1.4%) fracture had a complication of a fall and re-fracture. Extraphyseal fractures were more likely to increase in angulation at short term follow up, but had no association with short or long term complications. No patient initially treated with non-operative management subsequently underwent operative treatment. There were three presentations (4.3%) to health professionals for subsequent shoulder complaints; one was treated with short courses of physical therapy and the other two were simply observed. Conclusions: Non-displaced or minimally displaced proximal humerus fractures treated non-operatively sustain rare short or long term complications with no cross over to operative management. Once non-operative management is pursued, these fractures may be amenable to surveillance with primary care or allied orthopedic staff after initial evaluation by pediatric orthopedic providers.

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“…However, the accepted fragment size and distance to humerus were depended on the surgeon’s experience and lack of accurate assessment, which was a limitation of our study. A computed tomography (CT) scan or MRI may be helpful for more accurate assessment, but whether such a need exists remains to be discussed [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

The outcome of loose bone fragments in pediatric supracondylar humerus fractures: a retrospective study

Yang

et al. 2020

Journal of Pediatric Orthopaedics B

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We evaluated the clinical and imaging outcomes of loose bone fragments in children with supracondylar humerus fractures after closed reduction with percutaneous pin (CRPP) fixation. A retrospective review was conducted on 12 children with fragments on imaging after closed reduction of displaced humeral supracondylar fractures (Gartland III). Primary radiographic assessment included fragment outcome, postoperative Baumann angle, carrying angle and loss of reduction. Clinical outcome included the elbow range of motion (ROM), Flynn grade and other complications. Between January 2015 and January 2018, 460 children (2–14 years old) with supracondylar humerus fractures were treated at our center, including 12 (2.6%) with loose bone fragments on postoperative X-ray. Union or absorption of fragments was noted in all 12 patients at 1 year postoperatively, with good radiographic and clinical outcomes. The mean Baumann angle was 15.5° ± 4.3° and the mean carrying angle was 11.2° ± 2.8°. All patients had a normal elbow ROM. Ten patients achieved an excellent and two a good result according to the Flynn criteria. Good results were achieved after CRPP fixation in 12 children with supracondylar humerus fractures and loose bone fragments. The fragments were mainly absorbed or achieved union to the humerus within 1 year.

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The Utility of Routine Postoperative Radiographs After Pinning of Pediatric Supracondylar Humerus Fractures

Abstract: Level IV-case series.

Cited by 24 publications

References 32 publications

Is less more? Assessing the utility of early clinical and radiographic follow-up for operative supracondylar humerus fractures

Is less more? Assessing the utility of early clinical and radiographic follow-up for operative supracondylar humerus fractures

Rate of Complications and Subsequent Shoulder Complaints for Non-operatively Managed Pediatric Proximal Humerus Fractures

The outcome of loose bone fragments in pediatric supracondylar humerus fractures: a retrospective study

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