Thompson R M, Hubbard E W, Elliott M, Riccio A I, Sucato D J
Department of Orthopaedic Surgery, Orthopaedic Institute for Children/UCLA, Los Angeles, California, USA.
Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA.
J Child Orthop. 2018 Oct 1;12(5):502-508. doi: 10.1302/1863-2548.12.180054.
Postoperative protocols following surgical management of supracondylar humerus fractures (SCFs) are often based upon surgeon preference rather than clinical merit. The purpose of this study is to determine the utility of early clinical and radiographic follow-up.
A retrospective review of patients who underwent closed reduction and percutaneous pinning (CRPP) for SCF between 2009 and 2015 was performed using a database of prospectively-collected consecutive patient data. Previously undiagnosed neuropathies documented at the first postoperative visit were identified. Unscheduled visits and postoperative complications were compared between patients who were seen at one week and those with delayed first clinic visits.
Of 873 patients, 823 (94.3%) were seen within ten days of surgery (early follow-up) and 50 (5.7%) had a delayed first clinic appointment. Among patients seen for early follow-up, 12 (1.5%) had a previously undocumented neuropathy diagnosed but only eight (1%) had an alteration of management secondary to clinical findings. Greater than 90% of patients seen for early follow-up had radiographs performed, but only one had an alteration in management due to radiographic findings. Patients seen for early follow-up had the same rate of unscheduled visits (2.9% 4%, p = 0.66) and postoperative complications (1.6% 0%, p > 0.99) as those with delayed first appointments. Radiographic parameters were comparable at final follow-up (Baumann's angle 74.5° 73.7°, p = 0.40; lateral humeral condylar angle 40.2° 41.2°, p = 0.53).
The early follow-up visit after CRPP of SCF rarely leads to alterations in care and does not reduce unscheduled visits or late complications.
Level IV.
肱骨髁上骨折（SCF）手术治疗后的术后方案通常基于外科医生的偏好而非临床价值。本研究的目的是确定早期临床和影像学随访的效用。
使用前瞻性收集的连续患者数据数据库，对2009年至2015年间接受SCF闭合复位和经皮穿针固定（CRPP）的患者进行回顾性研究。确定首次术后访视时记录的先前未诊断出的神经病变。比较术后一周就诊的患者和首次门诊延迟就诊的患者的非计划就诊和术后并发症情况。
873例患者中，823例（94.3%）在术后十天内接受了随访（早期随访），50例（5.7%）首次门诊预约延迟。在接受早期随访的患者中，12例（1.5%）诊断出先前未记录的神经病变，但只有8例（1%）因临床发现而改变了治疗方案。超过90%接受早期随访的患者进行了影像学检查，但只有1例因影像学结果而改变了治疗方案。接受早期随访的患者与首次预约延迟的患者的非计划就诊率（2.9%对4%，p = 0.66）和术后并发症发生率（1.6%对0%，p > 0.99）相同。末次随访时影像学参数具有可比性（鲍曼角74.5°对73.7°，p = 0.40；肱骨外侧髁角40.2°对41.2°，p = 0.53）。
SCF的CRPP术后早期随访很少导致治疗改变，也不会减少非计划就诊或晚期并发症。
四级。
