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Pin tract infection of operatively treated supracondylar fractures in children: long-term functional outcomes and anatomical study.

Parikh SN, Lykissas MG, Roshdy M, Mineo RC, Wall EJ - J Child Orthop (2015)

Bottom Line: Both DASH and PREE scores were excellent at a mean of 18 years post-surgery.The risk of intracapsular pin placement using parallel lateral pins was found to be greater (p < 0.05) than either crossed or divergent lateral pinning configurations.Septic arthritis and osteomyelitis are rare complications; when they do occur, they seem to be associated with parallel lateral pin configuration, though a causal relationship could not be established from the current study.

View Article: PubMed Central - PubMed

Affiliation: Division of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 2017, Cincinnati, OH, 45229, USA, shital.parikh@cchmc.org.

ABSTRACT

Purpose: The purpose of our study was to determine the long-term functional outcomes of pin tract infection after percutaneous pinning of displaced supracondylar humeral fractures in children, and to evaluate the potential for intracapsular pin placement based on pin configuration in cadaveric elbows.

Methods: We conducted a retrospective review of all patients requiring percutaneous pinning in a single institution over a 19-year period. The functional outcome assessment consisted of a telephone interview using the Disabilities of the Arm, Shoulder and Hand (DASH)] Outcome Measure and the Patient-Rated Elbow Evaluation (PREE) questionnaires. The risk of intracapsular pin placement was studied in cadaveric elbows for the three most common pin configurations: divergent lateral, parallel lateral, and medial and lateral crossed pins.

Results: Of 490 children, 21 (4.3 %) developed pin tract infection. There were 15 (3.1 %) superficial and six (1.2 %) deep infections (osteomyelitis and septic arthritis). Both DASH and PREE scores were excellent at a mean of 18 years post-surgery. The risk of intracapsular pin placement using parallel lateral pins was found to be greater (p < 0.05) than either crossed or divergent lateral pinning configurations.

Conclusions: Most infections after pinning of supracondylar humerus fractures are superficial and can be managed with pin removal, oral antibiotics, and local wound care. Septic arthritis and osteomyelitis are rare complications; when they do occur, they seem to be associated with parallel lateral pin configuration, though a causal relationship could not be established from the current study. Satisfactory long-term outcomes of these deep infections can be expected when treated aggressively with surgical debridement and intravenous antibiotics.

No MeSH data available.


Related in: MedlinePlus

Schematic diagram showing the three different pin configurations: divergent lateral (pins A and B), parallel lateral (pins A and C) and crossed pins (pinsA and D)
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Fig1: Schematic diagram showing the three different pin configurations: divergent lateral (pins A and B), parallel lateral (pins A and C) and crossed pins (pinsA and D)

Mentions: In order to evaluate the potential for capsular penetration and intracapsular pin placement of the three common pin configurations used in clinical practice, six upper limbs from three fresh adult cadavers were used. There was no known history of traumatic injury or joint disease of the elbow. Three left and three right elbows were evaluated. Four pins were placed by one of the authors (SNP) in each elbow to simulate the three most common pin configurations: divergent lateral, parallel lateral, and crossed-pin configuration. Pin A was placed from the lateral side of the elbow to simulate the most lateral (radial) pin in all three configurations. Pin B was inserted from the lateral side of the elbow to simulate divergent pin configuration. Pin C represented parallel pin configuration, and pin D was the medial pin of the crossed-pin configuration (Fig. 1).Fig. 1


Pin tract infection of operatively treated supracondylar fractures in children: long-term functional outcomes and anatomical study.

Parikh SN, Lykissas MG, Roshdy M, Mineo RC, Wall EJ - J Child Orthop (2015)

Schematic diagram showing the three different pin configurations: divergent lateral (pins A and B), parallel lateral (pins A and C) and crossed pins (pinsA and D)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4549348&req=5

Fig1: Schematic diagram showing the three different pin configurations: divergent lateral (pins A and B), parallel lateral (pins A and C) and crossed pins (pinsA and D)
Mentions: In order to evaluate the potential for capsular penetration and intracapsular pin placement of the three common pin configurations used in clinical practice, six upper limbs from three fresh adult cadavers were used. There was no known history of traumatic injury or joint disease of the elbow. Three left and three right elbows were evaluated. Four pins were placed by one of the authors (SNP) in each elbow to simulate the three most common pin configurations: divergent lateral, parallel lateral, and crossed-pin configuration. Pin A was placed from the lateral side of the elbow to simulate the most lateral (radial) pin in all three configurations. Pin B was inserted from the lateral side of the elbow to simulate divergent pin configuration. Pin C represented parallel pin configuration, and pin D was the medial pin of the crossed-pin configuration (Fig. 1).Fig. 1

Bottom Line: Both DASH and PREE scores were excellent at a mean of 18 years post-surgery.The risk of intracapsular pin placement using parallel lateral pins was found to be greater (p < 0.05) than either crossed or divergent lateral pinning configurations.Septic arthritis and osteomyelitis are rare complications; when they do occur, they seem to be associated with parallel lateral pin configuration, though a causal relationship could not be established from the current study.

View Article: PubMed Central - PubMed

Affiliation: Division of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 2017, Cincinnati, OH, 45229, USA, shital.parikh@cchmc.org.

ABSTRACT

Purpose: The purpose of our study was to determine the long-term functional outcomes of pin tract infection after percutaneous pinning of displaced supracondylar humeral fractures in children, and to evaluate the potential for intracapsular pin placement based on pin configuration in cadaveric elbows.

Methods: We conducted a retrospective review of all patients requiring percutaneous pinning in a single institution over a 19-year period. The functional outcome assessment consisted of a telephone interview using the Disabilities of the Arm, Shoulder and Hand (DASH)] Outcome Measure and the Patient-Rated Elbow Evaluation (PREE) questionnaires. The risk of intracapsular pin placement was studied in cadaveric elbows for the three most common pin configurations: divergent lateral, parallel lateral, and medial and lateral crossed pins.

Results: Of 490 children, 21 (4.3 %) developed pin tract infection. There were 15 (3.1 %) superficial and six (1.2 %) deep infections (osteomyelitis and septic arthritis). Both DASH and PREE scores were excellent at a mean of 18 years post-surgery. The risk of intracapsular pin placement using parallel lateral pins was found to be greater (p < 0.05) than either crossed or divergent lateral pinning configurations.

Conclusions: Most infections after pinning of supracondylar humerus fractures are superficial and can be managed with pin removal, oral antibiotics, and local wound care. Septic arthritis and osteomyelitis are rare complications; when they do occur, they seem to be associated with parallel lateral pin configuration, though a causal relationship could not be established from the current study. Satisfactory long-term outcomes of these deep infections can be expected when treated aggressively with surgical debridement and intravenous antibiotics.

No MeSH data available.


Related in: MedlinePlus