Abstract
<title>Abstract</title> <p>Purpose Supracondylar fractures of the distal humerus represent 15% of pediatric fractures and are among the most common childhood injuries. For unstable fractures, closed reduction with pinning and splinting is standard. However, optimal pin removal timing remains unclear. This study assessed complications, particularly secondary displacement after early pin removal, in children treated for unstable supracondylar fractures. Method We retrospectively reviewed pediatric patients surgically treated for supracondylar humeral fractures at our institution between January 2015 and December 2024. Collected data included demographics, Rigault-Lagrange fracture stage, duration of pin immobilization, and complications, including pin tract infection and secondary displacement after pin removal. Results A total of 211 patients were included (mean age 6.5 ± 2.3 years). According to the Rigault-Lagrange classification, 87 fractures were stage 2, 54 were stage 3, and 70 were stage 4. The mean duration of pin fixation and splint immobilization was 23.6 ± 4.0 days and was not influenced by fracture stage or patient age. After pin removal, 3 patients showed a change in Baumann’s angle greater than 12° and no patients lost intersection of the anterior humeral line with the capitular ossification center. One patient needed early surgical revision for displacement before pin removal and no patient needed delayed humeral osteotomy. Conclusion Pin and splint removal 3 weeks after surgical treatment of supracondylar humeral fractures did not increase the risk of secondary displacement, irrespective of fracture stage. Early removal may also reduce complications associated with prolonged immobilization, such as pin tract infection and joint stiffness. Level of evidence: III (retrospective cohort study)</p>