Outcome after pin fixation of supracondylar humerus fractures in children: postoperative radiographic examinations are unnecessary

• Published in: Acta orthopaedica Vol. 88; no. 1; pp. 109 - 115
• Main Authors: Tuomilehto, Noora, Kivisaari, Reetta, Sommarhem, Antti, Nietosvaara, Aarno Y
• Format: Journal Article
• Language: English
• Published: England 01.02.2017
• Subjects: Adolescent; Bone Nails; Child; Child, Preschool; Female; Follow-Up Studies; Fracture Fixation, Internal - methods; Humans; Humeral Fractures - diagnosis; Humeral Fractures - surgery; Infant; Male; Postoperative Period; Radiography; Retrospective Studies; Time Factors; Treatment Outcome; Unnecessary Procedures
• ISSN: 1745-3682
• DOI: 10.1080/17453674.2016.1250058

Background and purpose - The quality of pin fixation of displaced supracondylar humerus fractures in children has not been assessed, and the clinical value of radiographic examinations after pin fixation is unclear. We evaluated pin configuration, quality of osteosynthesis, and outcome in 264 supracondylar fractures. The clinical significance of postoperative radiographs was analyzed. Patients and methods - 252 Gartland-III and 12 flexion-type supracondylar humerus fractures were pin-fixed in the periods 2002-2006 and 2012-2014. During 2012-2014, staff were intructed that postoperative radiographs should not be taken. Quality of reduction was assessed by measuring Baumann and lateral capitellohumeral angles (LCHA) and also by recording the crossing point of the anterior humeral line (AHL) with bony capitellum. Rotatory alignment was registered as normal or abnormal. Pin configuration and quality of osteosynthesis were evaluated. The clinical significance of postoperative radiographs was analyzed. Results - Postoperatively, Baumann angle was normal in 66% of the fractures, AHL crossed the capitellum in 84%, and no malrotation was evident in 85% of the fractures. Crossed pins were used in 89% of the cases. 2 or more pins fixed both fracture fragments in 66%. Radiographic examinations were inadequate for assessment of LCHA in 13%, of Bauman angle in 8%, of AHL in 2%, of rotation in 1%, and of pin fixation in 2% of the cases. Postoperative radiographs did not give useful information except in 1 patient who had corrective osteotomy. All 94 patients with follow-up (97%) who were treated during 2012-2014 were satisfied with the outcome. Interpretation - Despite pin fixation being deemed unsatisfactory in one-third of the cases, significant malunion was rare. Postoperative radiography did not alter management or outcome.