Uncomplicated Supracondylar Humerus Fractures in Pediatric Patients: Can Early Postsurgical Follow-Up Be Safely Avoided?

New research from the Division of Pediatric Orthopaedic Surgery at UPMC Children’s Hospital of Pittsburgh on postsurgical follow-up dynamics for supracondylar humerus fractures provides insights for surgeons on the necessity of early follow-up in certain cases. 

The study was published in January 2022 in the Journal of Pediatric Orthopaedics. Ozgur Dede, MD, associate professor of Orthopaedic Surgery in the Department of Orthopaedic Surgery at the University of Pittsburgh School of Medicine, was the study’s senior author. Stephanie Boden MD, orthopeadic surgery resident (PGY4) was the lead author of the study. Also collaborating on the investigation were Natalie Novak, clinical research coordinator in the Division; Tanya S. Kenkre from the Epidemiology Data Center at the University of Pittsburgh Graduate School of Public Health; and Ahmed Khedr, MD, PhD, from Cairo University in Egypt. Dr. Khedr was a previous clinical fellow with Dr. Dede during which time he contributed to this clinical research project.

Supracondylar humerus fractures are commonly treated surgically in children to achieve optimal outcomes when fractures are either displaced or angulated. While most fractures are repaired without incident or postsurgical complication, there are no consensus guidelines and limited evidence around the necessity for an early follow-up visit before the removal of percutaneous stabilizing pins and the effect of this early follow-up on outcomes or complication rates.

To better understand the potential need for, or ability to avoid an early follow-up visit for this patient population, the UPMC Children’s team reviewed cases of supracondylar humerus fractures of Gartland type II and III that were surgically repaired at the hospital from 2005 to 2015.

1,518 total cases were identified, 755 of which were type II and 765 were type III. 1,370 of the cases met the full inclusion criteria for analysis and included in the study.

While the vast majority of cases (1,196) were seen in early, first follow-up one to two weeks after surgery, a smaller cohort of 174 cases were seen for first follow-up at the three to four week time period.

There were no significant differences in postsurgical complications between the two patient cohorts suggesting that in uncomplicated cases with closed reduction and a stable fixation of the fracture, the early postoperative follow-up before pin removal can likely be avoided with no safety issues or increased rates of postsurgical complication. This finding may be helpful in decreasing the number of clinic visits for patients, especially in the era of a pandemic.

Read the full study and its findings using the below reference.

Reference

Boden SA, Khedr A, Novak NE, Kenkre TS, Dede O. Omitting the Early Postoperative Follow-up in Uncomplicated Operative Supracondylar Humerus Fractures in Children Does Not Negatively Affect Outcomes. J Pediatr Orthop. 2022 Feb 1; 42(2): e109-e114.