Acosta Anna M, Li Yi-Ju, Bompadre Viviana, Mortimer Alex, Trask Michael, Steinman Suzanne E
Pediatric Orthopedic Specialty Center, Memorial Care & Miller Children's and Women's Hospital of Long Beach, Long Beach, CA.
Department of Orthopedics and Sports Medicine, Chi-Mei Medical Center, Tainan, Taiwan (Republic of China).
J Pediatr Orthop. 2020 May/Jun;40(5):218-222. doi: 10.1097/BPO.0000000000001432.
Supracondylar humerus (SCH) fractures are common elbow injuries in pediatric patients. The American Academy of Orthopedic Surgeons published guidelines for the standard of care in the treatment of displaced SCH fractures, however, no recommendations for follow-up care were made. With the recent push to eliminate unnecessary radiographs and decrease health care costs, many are questioning postoperative protocols. The purpose of our study was to evaluate the utility of the 1-week follow-up appointment after closed reduction and percutaneous pinning (CRPP) of displaced SCH fractures.
A retrospective review performed at a single institution from 2014 to 2016 included patients under 14 years of age with a closed, displaced SCH fracture treated with CRPP. Exclusion criteria included patients without complete clinical or radiographic follow-up. Variables examined included time to initial follow-up, change in treatment plan after 1-week x-rays, complications, demographics, fracture type, pin number and configuration, reduction parameters, immobilization, time to pin removal, duration of casting, and clinical outcome.
A total of 412 patients were divided into 2 groups based on time to initial follow-up. Overall, 368 had an initial follow-up at 7 to 10 days (group 1) and 44 at 21 to 28 days (group 2). There was no difference in age, sex, fracture type, pin configuration, or a number of pins between groups. Statistically significant findings included time to initial follow-up and days to pin removal (group 1 at 26.2 d vs. group 2 at 23.8 d), type of immobilization (group 1 with 5% circumferential casts and group 2 with 70%), and time to surgery (26.2 vs. 62.9 h, respectively). There was no significant difference in complication rates and only a 0.5% rate of change in management in group 1.
Early postoperative follow-up and radiographs did not change the patient outcome and might be eliminated in children with displaced SCH fractures treated with CRPP. Given the current focus of on efficiency and cost-effective care, eliminating the 1-week postoperative appointment would improve appointment availability and decrease medical cost.
Level III-Therapeutic.
肱骨髁上骨折（SCH）是儿科患者常见的肘部损伤。美国矫形外科医师学会发布了关于移位性SCH骨折治疗的护理标准指南，然而，未对随访护理提出建议。随着近期减少不必要的X光检查及降低医疗成本的推动，许多人对术后方案提出质疑。我们研究的目的是评估移位性SCH骨折闭合复位经皮穿针固定（CRPP）后1周随访预约的效用。
对2014年至2016年在单一机构进行的一项回顾性研究，纳入年龄小于14岁、采用CRPP治疗的闭合性移位性SCH骨折患者。排除标准包括无完整临床或影像学随访的患者。检查的变量包括初次随访时间、1周X光检查后治疗计划的改变、并发症、人口统计学、骨折类型、针的数量和配置、复位参数、固定方式、拔针时间、石膏固定持续时间及临床结果。
根据初次随访时间，共412例患者分为2组。总体而言，368例在7至10天进行初次随访（第1组），44例在21至28天进行初次随访（第2组）。两组在年龄、性别、骨折类型、针的配置或针的数量方面无差异。具有统计学意义的结果包括初次随访时间和拔针天数（第1组为26.2天，第2组为23.8天）、固定方式（第1组为5%的环形石膏，第2组为70%）以及手术时间（分别为26.2小时和62.9小时）。并发症发生率无显著差异，第1组治疗方案的改变率仅为0.5%。
术后早期随访和X光检查并未改变患者的预后，对于采用CRPP治疗的移位性SCH骨折患儿，可能无需进行。鉴于当前对效率和成本效益护理的关注，取消术后1周的预约将提高预约的可及性并降低医疗成本。
三级治疗性。
