Animal-Assisted Therapy Reduces Patient Reported Pain During Office Pin Removal Following Supracondylar Humerus Fracture Fixation: A Randomized Controlled Study

BACKGROUND: Outpatient pin removal after pin fixation of supracondylar humerus (SCH) fractures is a frequent source of pain and anxiety in children. While pharmacologic and digital distraction strategies have demonstrated minimal efficacy in reducing procedural distress, animal-assisted therapy (AAT) remains an unexplored alternative in pediatric orthopaedics. The purpose of this study was to assess the effect of AAT on patient-reported pain and behavioral distress during office SCH pin removal. METHODS: A randomized controlled trial was conducted at a tertiary pediatric hospital. Pediatric patients aged 3 to 10 years undergoing office pin removal after SCH fracture fixation were randomized to pin removal with or without the presence of a certified therapy dog. Outcomes included patient-reported pain using the Wong-Baker FACES Pain Rating Scale, behavioral distress using the Face, Legs, Activity, Cry, and Consolability (FLACC) scale, heart rate measurements, and parental-reported anxiety assessed through survey. RESULTS: A total of 52 patients were enrolled in this study with 27 randomized to the Dog cohort and 25 to the control cohort. Patients in the Dog cohort demonstrated significantly lower patient-reported pain (FACES: 2.9 vs. 6.4, P<0.01) and behavioral distress (FLACC: 3.3 vs. 5.6, P=0.02) during pin removal. Peak heart rate was significantly lower in the Dog cohort (121.3 vs. 138.4 bpm, P=0.04), although change from baseline heart rate did not differ significantly (P=0.09). CONCLUSIONS: Animal-assisted therapy was associated with reduced patient-reported pain and behavioral distress during office SCH pin removal, supporting its role as a non-pharmacologic adjunct in pediatric orthopaedic care. LEVEL OF EVIDENCE: Level I, randomized controlled trial.