Pediatric Radiology

, Volume 45, Issue 8, pp 1169–1173 | Cite as

Imaging of the elbow in children with wrist fracture: an unnecessary source of radiation and use of resources?

  • Lauren P. Golding
  • Yousef Yasin
  • Jasmeet Singh
  • Bettina M. Gyr
  • Alison Gardner
  • Evelyn Anthony
Original Article



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.


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.


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.


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.


Children Elbow Forearm Fracture Radiography Wrist 


Conflicts of interest



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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Lauren P. Golding
    • 1
    • 4
  • Yousef Yasin
    • 1
  • Jasmeet Singh
    • 1
  • Bettina M. Gyr
    • 2
  • Alison Gardner
    • 3
  • Evelyn Anthony
    • 1
  1. 1.Department of RadiologyWake Forest University Baptist HealthWinston-SalemUSA
  2. 2.Department of Orthopedic SurgeryWake Forest University Baptist HealthWinston-SalemUSA
  3. 3.Department of Pediatric Emergency MedicineWake Forest University Baptist HealthWinston-SalemUSA
  4. 4.Triad Radiology AssociatesWinston-SalemUSA

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