Journal of Pediatric Orthopaedics - 2026-07-01 - Journal Article; Multicenter Study
Pediatric Supracondylar Humerus Fractures: The Utility of Post-Mobilization Follow-Up.
Tung WS, Muñoz T, Tan LYT, Reikersdorfer K, Arnold SC, Massoud JG, Ly TV, Paschos N
Topics
Key Takeaway
Early discharge after mobilization was feasible in 15.4% of pSCHF patients, with 72.6% of those requiring additional follow-up doing so for stiffness rather than structural complications.
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Summary
This multicenter retrospective cohort examined post-mobilization follow-up utility in 384 consecutive pSCHF patients managed between 2016 and 2024. Only 59 patients (15.4%) were discharged early after mobilization; increased fracture severity and intervention complexity were independently associated with need for additional follow-up (P<0.0001). Among patients requiring a second post-mobilization visit, 72.4% returned for stiffness and 7.9% for nerve palsy, with the majority discharged at that same visit.
Key Limitation
The 15.4% early discharge rate reflects surgeon-selected low-risk cases rather than a protocol-driven cohort, making it impossible to determine whether patients who were not discharged early could have been safely discharged.
Original Abstract
INTRODUCTION
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.
METHODS
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 χ 2 , Fisher's exact, Welch's T, and Mann-Whitney U tests, as appropriate.
RESULTS
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%).
CONCLUSIONS
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.