Analysis of the factors affecting pain level during K-wire removal among pediatric elbow fractures

Our aim was, to analyze the reasons for possible increased pain during the removal of the Kirschner wires from the elbows of children. From February 2021 to December 2021, 573 patients with elbow fractures were treated. In total, 150 patients were analyzed prospectively. No action was taken to reduce pain during the removal of Kirschner wires. The pain status of the patients was evaluated according to the Wong-Baker FACES Pain Rating scoring system (WBAS), the Numeric Rating Scale (NRS) for the pain system and the pulse and oxygen saturation measured by the pulse oximeter on the finger. Measurements were performed before, during, immediately after and 30 min after the procedure. There were 119 patients with a diagnosis of supracondylar humerus fracture and 31 patients with a diagnosis of lateral condyle fracture. The mean age of treated patients was 7.1 years (1-15 years). Of the patients, 93 were boys and 57 were girls. In the measurements made according to the sex difference, it was determined that there was a statistically significant increase in the WBAS scores measured both before the procedure ( P  = 0.032) and during the removal ( P  = 0.017), and also in the pulse measurements taken 30 min after the removal in girls ( P  = 0.034). A statistically significant difference was found in both the WBAS score during removal ( P  = 0.025) and the NRS scores 30 min later ( P  = 0.048) in the procedures performed on the right elbow. We found a statistically significant increase in the pain parameters we evaluated in girls, right extremity fractures, the group over 8 years old and when both parents were with the child during the K-wire removal procedure. In light of these findings, physicians should consider the above-mentioned conditions before starting the procedure to ensure a less painful and positive experience.

Down to the wire: Patient and family experiences of k-wire removal in a paediatric specialist clinic

INTRODUCTION

K-wire removal is a common procedure in the paediatric outpatient clinic that is a source of pain and anxiety. This study examined the current parental experience of k wire removal.

METHODS

Twenty-six parents of children having k-wires removed in a paediatric outpatient clinic were asked to complete an electronic survey immediately post procedure. Questions explored prior knowledge, sedation and analgesia for the procedure. Data analysis used descriptive statistics.

RESULTS

Verbal information from the ward prior to the procedure was the greatest information source for parents 22/26(85%). Thirty-eight % (10/26) of parents had expected sedation but only 6/10(23%) reported receiving sedation information. Only 7/26(27%) of parents reported their child receiving analgesia from themselves or medical staff pre-procedure.

DISCUSSION

Parents recommended the need for more procedural information beforehand, especially regarding pain and sedation. Parents were unaware of the option of sedation and wanted analgesia before the procedure.

Immersive virtual reality vs. non-immersive distraction for pain management of children during bone pins and sutures removal: A randomized clinical trial protocol

AIMS

To examine the efficacy of an immersive virtual reality distraction compared with an active non-immersive distraction, such as video games on a tablet, for pain and anxiety management and memory of pain and anxiety in children requiring percutaneous bone pins and/or suture removal procedures.

DESIGN

Three-centre randomized clinical trial using a parallel design with two groups: experimental and control.

METHODS

Study to take place in the orthopaedic department of three children hospital of the Montreal region starting in 2019. Children, from 7-17 years old, requiring bone pins and/or suture removal procedures will be recruited. The intervention group (N = 94) will receive a virtual reality game (Dreamland), whereas the control group (N = 94) will receive a tablet with video games. The primary outcomes will be both the mean self-reported pain score measured by the Numerical Rating Scale and mean anxiety score, measured by the Child Fear Scale. Recalls of pain and anxiety will be measured 1 week after the procedure using the same scales. We aim to recruit 188 children to achieve a power of 80% with a significance level (alpha) of 5%.

DISCUSSION

While multiple pharmacological methods have previously been tested for children, no studies have evaluated the impact of immersive virtual reality distraction for pain and anxiety management in the orthopaedic setting.

IMPACT

Improved pain management can be achieved using virtual reality during medical procedures for children. This method is innovative, non-pharmacological, adapted to the hospital setting, and user-friendly.

TRIAL REGISTRATION

NCT03680625, registered on clinicaltrials.gov.

Pain during office removal of K-wires from the elbow in children

BACKGROUND

Closed reduction and K-wire fixation is standard treatment for displaced supracondylar fractures in children. The purpose of this study is to evaluate pain using 2 pediatric pain scales when removing K-wires from the distal humerus in children in the office setting.

METHODS

A total of 98 percutaneous smooth K-wires were removed from 47 patients who had sustained displaced supracondylar fractures of the elbow. Pain was measured using the Children's Hospital of Eastern Ontario Pain Scale (CHEOPS). The maximum score is 13 and the minimum score is 4 points. In addition, after K-wire removal, each child indicated on a numbered pain-face diagram (Wong-Baker FACES: a scale consisting of faces with varying emotional expressions and corresponding numbers on a scale from 0 to 5) the amount of pain that they felt.

RESULTS

The average age of the patients treated was 7.1 years (range, 2 to 14 y). There were 28 males and 19 females. Thirty patients (64%) had a CHEOPS score of ≤6. The average CHEOPS was 6 (range, 4 to 10). Seventeen patients (37%) had a FACES score of ≤1. The average FACES score was 2 (range, 1 to 5). Higher CHEOPS and FACES scores correlated with younger patient age and higher number of K-wires removed.

CONCLUSIONS

K-wire removal in the clinic is common practice. The pain associated with K-wire removal and the safety of this practice has received minimal previous study in the literature. In the present manuscript, 64% of patients had little or no pain measured by the CHEOPS scale--score of ≤6 and 36% had little or no pain self-reported by the FACES scale--score of ≤1. No patient reported severe pain by the CHEOPS scores (CHEOPS 11 to 13) and only 1 patient reported having severe pain with a FACES of 5. No complications occurred. The results of this study suggest that the removal of K-wires in the office setting is safe and acceptable.

LEVEL OF EVIDENCE

Retrospective analysis.