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.
OBJECTIVE
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.
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.
Sumeet
S
Garg
Musculoskeletal Research Center, Orthopaedics Institute, Children's Hospital Colorado, Aurora, Colorado, USA.
Nikki
N
Bloch
Musculoskeletal Research Center, Orthopaedics Institute, Children's Hospital Colorado, Aurora, Colorado, USA.
Micaela
M
Cyr
Musculoskeletal Research Center, Orthopaedics Institute, Children's Hospital Colorado, Aurora, Colorado, USA.
Patrick
P
Carry
Pediatric; Pin removal; Radiographs; Supracondylar humerus fracture; Type 2