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Routine radiographs at time of pin removal after closed reduction and percutaneous pinning for type 2 supracondylar humerus fractures do not change management: a retrospective cohort study.

Garg S, Bloch N, Cyr M, Carry P - J Child Orthop (2016)

Bottom Line: No cases of neurologic or vascular injury, re-fracture, or loss of reduction occurred.Of 389 patients, 75 (19 %) had no documented reason for extended casting, four (1 %) were extended based on physician evaluation of radiographs, and seven (2 %) were extended for other reasons.If continuing to obtain radiographs at pin removal, we recommend removing pins before taking radiographs to reduce patient fear and anxiety from visualizing percutaneous pins.

View Article: PubMed Central - PubMed

Affiliation: Pediatric Orthopaedics and Spine Surgery, Orthopaedics Institute, Children's Hospital Colorado, 13123 East 16th Avenue, Box 060, Aurora, CO, 80045, USA. sumeet.garg@childrenscolorado.org.

ABSTRACT

Purpose: Radiographs are usually taken on day of pin removal for children treated with closed reduction and percutaneous pinning (CRPP) of type 2 supracondylar humerus fractures. The purpose of this study was to determine whether radiographs taken at time of pin removal for patients recovering uneventfully alter management.

Methods: After IRB approval, billing records identified 1213 patients aged 1-10 years who underwent elbow surgery between 2007 and 2013 at our institution for a supracondylar humerus fracture. Of these patients, 389 met inclusion criteria. Clinical charts were reviewed for demographics, operative details, and clinical follow-up, focusing on clinical symptoms present at pin removal. Radiographs taken at time of pin removal and subsequent visits were assessed for healing and fracture alignment.

Results: In no case was pin removal delayed based on radiographs. One hundred and nineteen (31 %) patients had radiographs taken following pin removal; in no case was loss of reduction found among these patients. No cases of neurologic or vascular injury, re-fracture, or loss of reduction occurred. Infection occurred in 12 patients (3 %). Pins were kept in place for 23.8 ± 4.4 days. Eighty-six patients (22 %) had additional intervention after pin removal (cast application in all cases). Of 389 patients, 75 (19 %) had no documented reason for extended casting, four (1 %) were extended based on physician evaluation of radiographs, and seven (2 %) were extended for other reasons.

Conclusions: Elimination of radiographs at time of pin removal should be considered. If continuing to obtain radiographs at pin removal, we recommend removing pins before taking radiographs to reduce patient fear and anxiety from visualizing percutaneous pins.

No MeSH data available.


Related in: MedlinePlus

Example of radiograph at time of pin removal for a patient whose immobilization was extended based on surgeon interpretation of radiographic findings
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Fig2: Example of radiograph at time of pin removal for a patient whose immobilization was extended based on surgeon interpretation of radiographic findings

Mentions: We identified only four (1 %) subjects where a surgeon documented their assessment of poor fracture healing on radiographs; in no other instance was the radiographic appearance of the humerus at time of pin removal felt to alter management. In these cases, the radiographs at pin removal do not show any obvious evidence of delayed healing or fracture malalignment based on review of de-identified images by the senior author. An example of one of these cases is shown in Fig. 2. Notably, pin removal was not delayed in these cases, rather immobilization was extended. Consistent with our hypothesis, the proportion of subjects that required post-operative care modifications on the basis of radiographic findings was significantly less than 5 %.Fig. 2


Routine radiographs at time of pin removal after closed reduction and percutaneous pinning for type 2 supracondylar humerus fractures do not change management: a retrospective cohort study.

Garg S, Bloch N, Cyr M, Carry P - J Child Orthop (2016)

Example of radiograph at time of pin removal for a patient whose immobilization was extended based on surgeon interpretation of radiographic findings
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4940239&req=5

Fig2: Example of radiograph at time of pin removal for a patient whose immobilization was extended based on surgeon interpretation of radiographic findings
Mentions: We identified only four (1 %) subjects where a surgeon documented their assessment of poor fracture healing on radiographs; in no other instance was the radiographic appearance of the humerus at time of pin removal felt to alter management. In these cases, the radiographs at pin removal do not show any obvious evidence of delayed healing or fracture malalignment based on review of de-identified images by the senior author. An example of one of these cases is shown in Fig. 2. Notably, pin removal was not delayed in these cases, rather immobilization was extended. Consistent with our hypothesis, the proportion of subjects that required post-operative care modifications on the basis of radiographic findings was significantly less than 5 %.Fig. 2

Bottom Line: No cases of neurologic or vascular injury, re-fracture, or loss of reduction occurred.Of 389 patients, 75 (19 %) had no documented reason for extended casting, four (1 %) were extended based on physician evaluation of radiographs, and seven (2 %) were extended for other reasons.If continuing to obtain radiographs at pin removal, we recommend removing pins before taking radiographs to reduce patient fear and anxiety from visualizing percutaneous pins.

View Article: PubMed Central - PubMed

Affiliation: Pediatric Orthopaedics and Spine Surgery, Orthopaedics Institute, Children's Hospital Colorado, 13123 East 16th Avenue, Box 060, Aurora, CO, 80045, USA. sumeet.garg@childrenscolorado.org.

ABSTRACT

Purpose: Radiographs are usually taken on day of pin removal for children treated with closed reduction and percutaneous pinning (CRPP) of type 2 supracondylar humerus fractures. The purpose of this study was to determine whether radiographs taken at time of pin removal for patients recovering uneventfully alter management.

Methods: After IRB approval, billing records identified 1213 patients aged 1-10 years who underwent elbow surgery between 2007 and 2013 at our institution for a supracondylar humerus fracture. Of these patients, 389 met inclusion criteria. Clinical charts were reviewed for demographics, operative details, and clinical follow-up, focusing on clinical symptoms present at pin removal. Radiographs taken at time of pin removal and subsequent visits were assessed for healing and fracture alignment.

Results: In no case was pin removal delayed based on radiographs. One hundred and nineteen (31 %) patients had radiographs taken following pin removal; in no case was loss of reduction found among these patients. No cases of neurologic or vascular injury, re-fracture, or loss of reduction occurred. Infection occurred in 12 patients (3 %). Pins were kept in place for 23.8 ± 4.4 days. Eighty-six patients (22 %) had additional intervention after pin removal (cast application in all cases). Of 389 patients, 75 (19 %) had no documented reason for extended casting, four (1 %) were extended based on physician evaluation of radiographs, and seven (2 %) were extended for other reasons.

Conclusions: Elimination of radiographs at time of pin removal should be considered. If continuing to obtain radiographs at pin removal, we recommend removing pins before taking radiographs to reduce patient fear and anxiety from visualizing percutaneous pins.

No MeSH data available.


Related in: MedlinePlus