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

• Published in: Pediatric radiology Vol. 45; no. 8; pp. 1169 - 1173
• Main Authors: Golding, Lauren P., Yasin, Yousef, Singh, Jasmeet, Gyr, Bettina M., Gardner, Alison, Anthony, Evelyn
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.07.2015; Springer Nature B.V
• Subjects: Adolescent; Child; Child, Preschool; Elbow Joint - diagnostic imaging; Female; Fractures, Bone - diagnostic imaging; Humans; Imaging; Infant; Male; Medicine; Medicine & Public Health; Neuroradiology; Nuclear Medicine; Oncology; Original Article; Pediatrics; Radiation Exposure - prevention & control; Radiography; Radiology; Ultrasound; Wrist Injuries - diagnostic imaging; Wrist Joint - diagnostic imaging; Radiography; Wrist; Fracture; Forearm; Children; Elbow
• ISSN: 0301-0449; 1432-1998
• DOI: 10.1007/s00247-015-3304-1

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.