Should Postoperative X-Rays be done in Supracondylar Humerus Fractures after Pinning?

Abstract

Background: Most author advocates the need for early postoperative clinical and radiographic follow-up in operative treatment of completely displaced supracondylar fractures of the humerus in children but in central India specially rural population is there, for whom it is difficult to get weekly X-rays done. Therefore we decided to determine the necessity of postoperative x rays after k-wire fixation for the operative treatment of completely displaced supracondylar fractures of the humerus in children.

Methods: 103 patients who underwent operative management of Gartland type III fractures at our institution from November 2012 to January 2016 were reviewed. Intraoperative C-arm images were compared with postoperative radiographs to identify changes in fracture alignment and k-wire placement.

Results: A total of 103 patients (48 females, 55 males) with a mean age of 7.1 years (range, 3.1 to 12.0) were reviewed which were classified as type III. Fracture displacement or k-wire back out was seen in three patients (2.9%) at the first postoperative visit. None of these patients required further operative management. On statistical evaluation, no significant difference was seen in terms of time to first postoperative visit, days to k-wire removal, or average follow-up time. The overall complication rate was 7.76% (9/103)

Conclusions: Fracture displacement and k-wire migration observed in postoperative radiographs after k-wire fixation of supracondylar humerus fractures have little effect on clinical management or long-term complication. Radiographs can therefore be delayed until the time of k-wire removal provided sufficient intraoperative stability was obtained.