Does Pin Removal at Three Versus Five Weeks Influence Clinical Outcomes in Gartland Type III Supracondylar Humerus Fractures? A Comparative Study.
TL;DR
Within the commonly practiced third-to-fifth-week interval, timing of pin removal does not appear to influence final clinical outcomes in pediatric Gartland type 3 supracondylar humerus fractures.
Abstract
Objective
The optimal timing of pin removal following closed reduction and percutaneous pinning (CRPP) for pediatric Gartland type 3 supracondylar humerus fractures remains controversial. Although pins are commonly removed between the third and fifth postoperative weeks, high-level evidence comparing clinical and radiological outcomes between these time points is limited. This study aimed to evaluate whether pin removal at the third vs. the fifth postoperative week influences radiographic healing or functional outcomes.
Methods
This retrospective observational study included 95 pediatric patients (aged 3-10 years) with Gartland type 3 supracondylar humerus fractures treated with CRPP between 2020 and 2025. Patients were divided into 2 groups based on the timing of pin removal: the third week (n = 42) and the fifth week (n = 53). Clinical outcomes included elbow range of motion (ROM), carrying angle difference, and the Flynn criteria at 3 and 6 months. Radiological outcomes included Baumann angle, anterior humeral line alignment, and the Radiographic Union Score for Tibia scores. Multivariable linear regression was performed to control for potential confounders. Interobserver reliability was assessed using intraclass correlation coefficients.
Results
At 3 months, flexion and extension loss were modestly lower in the third-week group (P = .011, r = 0.26 and P = .031, r = 0.22, respectively). However, no significant differences were observed between groups at 6 months in terms of flexion loss, extension loss, total motion loss, carrying angle difference, or Flynn scores (all P > .05). Radiographic Union Score for Tibia scores at the time of pin removal were higher in the fifth-week group (P < .001), reflecting later radiographic assessment; however, no differences were observed at subsequent follow-ups. No cases of loss of reduction, angular deformity, or reoperation occurred in either group. Multivariable analysis demonstrated that pin removal timing was associated with early but not late motion loss.
Conclusion
Pin removal at the third postoperative week did not compromise final radiological outcomes. In contrast, removal at the fifth week did not confer superior long-term functional recovery. Within the commonly practiced third-to-fifth-week interval, timing of pin removal does not appear to influence final clinical outcomes in pediatric Gartland type 3 supracondylar humerus fractures. Cite this article as: Çevik N, Akalın Y, Bayrak HÇ, et al. Does pin removal timing influence outcomes in Gartland type 3 supracondylar humerus fractures? A comparative study of third- and fifth-week removal. Acta Orthop Traumatol Turc., 2026; 60(4), 0936, doi: 10.5152/j.aott.2026.26936.