Zakrzewski Allyson M, Ferrick Michael R
Department of Orthopaedics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY.
J Pediatr Orthop. 2021 Feb 1;41(2):105-110. doi: 10.1097/BPO.0000000000001726.
The utility of routine follow-up radiographs for the treatment of nondisplaced pediatric supracondylar humerus fractures has not been established. The purpose of this study is to (1) determine the frequency that postcast removal x-rays change patient management and (2) determine the role of routine follow-up for range of motion evaluation after cast removal in the treatment of nondisplaced supracondylar humerus fractures.
We conducted a single center retrospective chart review of patients under the age of 18 years old that sustained nondisplaced supracondylar humerus fractures between January 1, 2010 and July 1, 2018. Demographic information, fracture characteristics, time to follow-up and each appointment outcome were recorded. A change in patient management after postcast removal x-ray was defined as a need for an additional period of immobilization, a delay in initiation of range of motion exercises, or need for operative intervention. In addition, the appointment for range of motion evaluation was considered to alter management if further activity restriction was required, a formal physical therapy program was recommended or an additional office visit required. Unscheduled appointments were also noted.
A total of 489 patients met inclusion criteria. The average age was 4.90±2.68 years and 51.8% were female. A total of 487 patients had routine follow-up x-rays after cast removal. No patient had a change of management based on postcast removal radiographs. In all, 290 patients returned for range of motion follow-up with 94.8% of patients being discharged from care. There were 14 patients whose management changed based on this evaluation (4.8%). The most common reason was an additional appointment for range of motion evaluation (12/14 patients, 86%). There were 13 patients with unscheduled evaluation after discharge from care, 77% were secondary to repeat injury.
This study suggests that postcast removal x-rays and routine follow-up after cast removal rarely change patient management and may not be necessary in the treatment of nondisplaced pediatric supracondylar humerus fractures.
Level IV-case series.
常规随访X线片在小儿无移位肱骨髁上骨折治疗中的作用尚未明确。本研究的目的是：（1）确定拆除石膏后X线片改变患者治疗方案的频率；（2）确定拆除石膏后进行常规随访以评估活动范围在小儿无移位肱骨髁上骨折治疗中的作用。
我们对2010年1月1日至2018年7月1日期间发生无移位肱骨髁上骨折的18岁以下患者进行了单中心回顾性病历审查。记录人口统计学信息、骨折特征、随访时间和每次就诊结果。拆除石膏后X线片检查后患者治疗方案的改变定义为需要额外的固定期、延迟开始活动范围锻炼或需要手术干预。此外，如果需要进一步限制活动、建议进行正式的物理治疗计划或需要额外就诊，则认为活动范围评估的就诊会改变治疗方案。还记录了非计划内的就诊情况。
共有489例患者符合纳入标准。平均年龄为4.90±2.68岁，51.8%为女性。共有487例患者在拆除石膏后进行了常规随访X线检查。没有患者因拆除石膏后的X线片而改变治疗方案。总共有290例患者返回进行活动范围随访，94.8%的患者出院。有14例患者的治疗方案基于此评估而改变（4.8%）。最常见的原因是额外进行活动范围评估就诊（12/14例患者，86%）。有13例患者在出院后进行了非计划内评估，77%继发于再次受伤。
本研究表明，拆除石膏后X线片检查和拆除石膏后的常规随访很少改变患者治疗方案，在小儿无移位肱骨髁上骨折治疗中可能没有必要。
IV级——病例系列。
