Abstract
Background
Anecdotally accepted practice for evaluation of children with clinically suspected or radiographically proven wrist fracture in many urgent care and primary care settings is concurrent imaging of the forearm and elbow, despite the lack of evidence to support additional images. These additional radiographs may be an unnecessary source of radiation and use of health care resources.
Objective
Our study assesses the necessity of additional radiographs of the forearm and elbow in children with wrist injury.
Materials and methods
We reviewed electronic medical records of children 17 and younger in whom wrist fracture was diagnosed in the emergency department. We identified the frequency with which additional radiographs of the proximal forearm and distal humerus demonstrated another site of acute injury.
Results
We identified 214 children with wrist fracture. Of those, 129 received additional radiographs of the elbow. Physical examination findings proximal to the wrist were documented in only 16 (12%) of these 129 children. A second injury proximal to the wrist fracture was present in 4 (3%) of these 129 children, all of whom exhibited physical examination findings at the elbow. No fractures were documented in children with a negative physical examination of the elbow.
Conclusion
Although elbow fractures occasionally complicate distal forearm fractures in children, our findings indicate that a careful physical evaluation of the elbow is sufficient to guide further radiographic investigation. Routine radiographs of both the wrist and elbow in children with distal forearm fracture appear to be unnecessary when an appropriate physical examination is performed.
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References
Khosla S, Melton LJ 3rd, Dekutoski MB et al (2003) Incidence of childhood distal forearm fractures over 30 years: a population-based study. JAMA 290:1479–1485
Bailey DA, Wedge JH, McCulloch RG et al (1989) Epidemiology of fractures of the distal end of the radius in children as associated with growth. J Bone Joint Surg Am 71:1225–1231
Nellans KW, Kowalski E, Chung KC (2012) The epidemiology of distal radius fractures. Hand Clin 15:113–125
Bae DS, Waters PM (2006) Pediatric distal radius fractures and triangular fibrocartilage complex injuries. Hand Clin 22:43–45
Pershad J, Monroe K, King W et al (2000) Can clinical parameters predict fractures in acute pediatric wrist injuries? Acad Emerg Med 7:1152–1155
Parmelee-Peters K, Eathorne SW (2005) The wrist: common injuries and management. Prim Care 32:35–70
Roposch A, Reis M, Molina M et al (2001) Supracondylar fractures of the humerus associated with ipsilateral forearm fractures in children: a report of forty-seven cases. J Pediatr Orthop 21:307–312
Templeton PA, Graham HK (1995) The ‘floating elbow’ in children. Simultaneous supracondylar fractures of the humerus and of the forearm in the same upper limb. J Bone Joint Surg (Br) 77:791–796
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Golding, L.P., Yasin, Y., Singh, J. et al. Imaging of the elbow in children with wrist fracture: an unnecessary source of radiation and use of resources?. Pediatr Radiol 45, 1169–1173 (2015). https://doi.org/10.1007/s00247-015-3304-1
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DOI: https://doi.org/10.1007/s00247-015-3304-1