Time to Pin Removal in Pediatric Supracondylar Humerus Fractures: The Pros and Cons

Abstract Background: Supracondylar humerus fractures (SHFs) are the most common elbow fractures in pediatric population; closed reduction with percutaneous pinning (CRPP) remains the gold standard of treating displaced fractures. Following surgery, removal of pins at 34 weeks is usually recommended. Prolonged pin fixation may result in higher risks of skin erosion, pin tract infection, and delayed recovery, while early pin removal may increase risks of loss of reduction or refracture due to inadequate union. Objectives: According to our knowledge, recent literature had not reported the outcomes comparing different timing of pin removal. The study aims to investigate the pros and cons of the timing of pin removal in pediatric SHFs treated with CRPP. Materials and Methods: This study was a single-center retrospective study of all cases of SHFs treated with CRPP from 2002 to 2022. According to the time of pin removal, patients were divided into three groups: Early pin removal (<3 weeks), intermediate (3–4 weeks), and late pin removal (more than 4 weeks). Primary outcomes include fracture union and elbow range of motion. Secondary outcomes include radiological assessments and complications. Results: A total of 122 patients were included in the final analysis, with 14 patients categorized in the early pin removal group, 49 patients in the intermediate group, and 59 in the late pin removal group. Patient demographic data show no difference in age, sex, fracture type, or follow-up period between groups. No cases of loss of reduction or refracture after pin removal were recorded. Moreover, there was no significant difference in functional or radiological outcomes. Conclusions: The findings support the feasibility of considering earlier pin removal in cases with bone callus formation observed on radiographs in SHFs according to the surgeon’s discretion. Further prospective studies with larger cohorts are warranted to provide more definitive evidence.