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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

Anteroposterior radiograph demonstrating the relationship of the pins to the capsule. The arthrogram shows that the medial pin (white arrow) is extracapsular. Laterally, pins A  and B appear to be extracapsular, and pin C appears to be intracapsular
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Fig2: Anteroposterior radiograph demonstrating the relationship of the pins to the capsule. The arthrogram shows that the medial pin (white arrow) is extracapsular. Laterally, pins A and B appear to be extracapsular, and pin C appears to be intracapsular

Mentions: Once all four pins were placed, an arthrogram was performed under fluoroscopic image guidance by injecting 5 ml of Conray contrast media (Mallinckrodt Pharmaceuticals, St. Louis, MO, USA) into the elbow joint (Fig. 2). This was followed by dissection of both the lateral and medial aspect of the elbow to determine the distance of each pin from the elbow joint capsule. Each lateral pin–capsule distance was measured from the anterior, inferior, and posterior margins of the capsule (Fig. 3). The medial pin-to-capsule distance was measured from the medial margin of the capsule. Statistical comparison of different groups was performed using two-tailed Wilcoxon signed-rank tests. This non-parametric test was selected due to the small sample size and non-normal distribution of data, and accordingly, medians and interquartile ranges (IQR) are reported instead of means and standard deviations. In all instances, p < 0.05 was regarded as statistically significant.Fig. 2


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)

Anteroposterior radiograph demonstrating the relationship of the pins to the capsule. The arthrogram shows that the medial pin (white arrow) is extracapsular. Laterally, pins A  and B appear to be extracapsular, and pin C appears to be intracapsular
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig2: Anteroposterior radiograph demonstrating the relationship of the pins to the capsule. The arthrogram shows that the medial pin (white arrow) is extracapsular. Laterally, pins A and B appear to be extracapsular, and pin C appears to be intracapsular
Mentions: Once all four pins were placed, an arthrogram was performed under fluoroscopic image guidance by injecting 5 ml of Conray contrast media (Mallinckrodt Pharmaceuticals, St. Louis, MO, USA) into the elbow joint (Fig. 2). This was followed by dissection of both the lateral and medial aspect of the elbow to determine the distance of each pin from the elbow joint capsule. Each lateral pin–capsule distance was measured from the anterior, inferior, and posterior margins of the capsule (Fig. 3). The medial pin-to-capsule distance was measured from the medial margin of the capsule. Statistical comparison of different groups was performed using two-tailed Wilcoxon signed-rank tests. This non-parametric test was selected due to the small sample size and non-normal distribution of data, and accordingly, medians and interquartile ranges (IQR) are reported instead of means and standard deviations. In all instances, p < 0.05 was regarded as statistically significant.Fig. 2

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