Late Deep Infections Complicating Percutaneous Pinning of Supracondylar Humerus Fractures

Abstract

Objectives: Complications following treatment of supracondylar humerus fractures are typically seen shortly postoperatively. Late complications occurring years after percutaneous pinning are rare but can be indolent and have permanent sequelae. We present cases of children presenting with late deep infections to discuss their diagnosis and treatment.

Methods: After institutional review board approval, we retrospectively reviewed records of three children who developed deep infections at least one year after percutaneous pinning of their supracondylar humerus fracture. Patient details and outcomes were analyzed. Radiographs and magnetic resonance imaging were reviewed along with each patient's clinical course and treatment.

Results: We report 3 cases of osteomyelitis and/or septic arthritis presenting at least one year after supracondylar humerus fractures treated with closed reduction and percutaneous pinning. The patients required several irrigation and debridement procedures with placement of antibiotic beads in addition to a prolonged course of antibiotics.

Conclusion: Delayed deep infections can occur after closed reduction and percutaneous pinning of supracondylar humerus fractures in children. Vigilance is required to diagnose and treat such occurrences, and prolonged follow-up is needed to monitor for recurrent or intractable infections.

Figure 1

(a–c) AP, lateral, and oblique MRI of the right elbow with a subtle area of lucency (arrows) in the metaphysis. (d) Axial T1 postcontrast MRI with an enhancing lesion (large arrow) in the bone with anterior cortical disruption and enhancement anterior to the humerus extending to the lateral sinus tract (small arrow).

Figure 2

(a, b) AP and lateral x-rays showing a distal humeral lucency concerning for chronic osteomyelitis. (c, d) Axial T1 post contrast MRI. (c) The large arrow denotes nidus of infection. (d) The large arrow denotes anterior cortical disruption. The small arrows denote purulent fluid collection in elbow joint. (e) and (f) are radiographs one year after irrigation and debridement.