Anxiety surrounding supracondylar humerus pin removal in children

Routine evaluation of supracondylar humerus fracture percutaneous pin sites does not decrease complications: a retrospective comparative cohort

BACKGROUND

Supracondylar humerus (SCH) fractures are the most common type of pediatric elbow fractures that require surgical intervention. Studies suggest limiting the first postoperative visit to the time of pin removal or limiting radiographs at first postoperative follow-up may not increase complication rates, but few comparative studies exist. This study aims to determine if routinely examining surgical pins sites at the first postoperative visits affects the complication rates or outcomes compared to only evaluating pin sites if a clinical indication exists.

METHODS

This cohort study retrospectively reviewed patients who were surgically treated for a supracondylar humerus fracture at a Pediatric Level 1 Trauma Hospital from 2011-2017. Clinical records and surgical reports were reviewed, and data was extracted to determine fracture type, surgical treatment, and postoperative course. Complications were recorded.

RESULTS

Three hundred and fifty-five patients were included; 138 patients had a routine pin evaluation at first postoperative visit, 183 had no pin evaluation until time of pin removal, and 34 had a clinical indication for pin site evaluation at the initial postoperative visit. No patients in the routine pin evaluation or the no early pin evaluation group had a loss of reduction. In the clinical indication group, three patients returned to the operating room (8.82%) due to a loss of reduction, as determined by radiographs. No significant differences were found in healing outcomes or complications between the group that had a routine evaluation versus the group that did not.

CONCLUSION

Routine pin site evaluation in the initial postoperative setting after closed or open reduction and pinning of supracondylar humerus fractures without clinical indication does not lead to fewer complication, return to operating room, or improved outcomes. The initial dressing and immobilization can be continued until pin removal unless clinical/radiographic indication to evaluate pin sites exists.

LEVEL OF EVIDENCE

Level III.

Animated video reduces pain and anxiety during pin removal in children with supracondylar humerus fractures: a randomized controlled trial

INTRODUCTION

The aim of this study; is to determine the level of pain and anxiety experienced by pediatric patients with operated humeral supracondylar fractures during pin removal, and to investigate the effectiveness of animated video impressions.

MATERIALS AND METHODS

This randomized controlled study included 180 patients aged between 4 and 12 years. The patients were divided into four groups: Group 1-control; Group 2-watched the introductory animation video before the procedure; Group 3-using analgesic before the procedure (ibuprofen 10 mg/kg); Group 4-watched the introductory animation video and used analgesic before the procedure. To assess pain before randomization, before-during-after procedure, and at outpatient clinic controls; the Wong-Baker Pain Scale (WBS), modified CHEOPS (Children's Hospital of Eastern Ontario Pain Scale), and the child's heart rate were used. To assess anxiety; the Children's Anxiety Meter (CAM), The Short State Anxiety Inventory Scale (SAIS), and The Children's Emotion Management Scales (CEMS) were used.

RESULTS

While a significant difference was detected between the groups in the tests performed at certain intervals (p < 0.001), no significant difference was detected between Groups 1-3 and Groups 2-4. The Modified CHEOPS and CEMS values obtained during the procedure showed significant variability between the groups (p < 0.001). Similarly, While a significant difference was detected between the groups in the WBS scores measured during the procedure (p < 0.001), it was observed that there was no significant relationship between Groups 1-3 and Groups 2-4 (p = 0.892, p = 0.820).

CONCLUSIONS

Watching an introductory animated video before pin removal is an effective method to relieve the anxiety and pain felt in children with supracondylar fractures.