Pediatric Supracondylar Humerus Fractures: The Utility of Post-Mobilization Follow-Up.

Abstract

There is currently no universally accepted follow-up protocol for pediatric supracondylar humerus fractures (pSCHFs), but post-mobilization follow-ups are commonly scheduled to evaluate range of motion and the presence of deformities. Recent practice has trended towards enhancing efficiency by reducing unnecessary clinic visits for uncomplicated fractures. This study examines follow-up practices after pSCHFs at our multicenter institution, evaluating the utility of post-mobilization follow-up visits, and determining appropriate criteria for safe early discharge. All consecutive pediatric patients who underwent definitive management for pSCHFs between January 1, 2016, and March 1, 2024, at our multicenter institution were screened. Patients were stratified and analyzed based on their discharge status and need for additional follow-up post-mobilization. Patient, injury, and treatment characteristics were compared using χ2, Fisher's exact, Welch's T, and Mann-Whitney U tests, as appropriate. Of the 384 patients included in this analysis, 59 (15.4%) were discharged early after elbow mobilization. Increased fracture severity and intervention complexity were significantly associated with the need for additional follow-up (both P<0.0001). This association was also evident among patients discharged after one post-mobilization follow-up visit (201/277; 72.6%), as compared with those who were not (76/277; 27.4%) (P<0.0001). Subsequent follow-ups were primarily indicated for stiffness (55/76; 72.4%), followed by nerve palsy (6/76; 7.9%). Early discharge of pediatric patients from clinic after fracture healing, cast removal, and mobilization of supracondylar humerus fractures is a feasible, yet underutilized practice. Most patients who returned to clinic after mobilization did not present any concerns of stiffness or loss of function and were discharged during the same visit. Our findings suggest that for patients with uncomplicated fractures (Gartland I-III), early discharge after mobilization may be acceptable if no immediate complications are identified. However, it is crucial to advise patients and their families to seek follow-up care if a significant functional deficit or a change in recovery is observed in the injured arm after discharge. All red flags are discussed with the families during their follow-up visit.