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Arch Pediatr Adolesc Med. 1999 Sep;153(9):923-5.

The role of serial radiographs in the management of pediatric torus fractures.

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  • 1Department of Pediatrics, Boston University School of Medicine, Boston Medical Center, MA 02118, USA.

Abstract

OBJECTIVES:

To assess the utility of radiographs taken immediately after the application of a cast in the management of pediatric torus (or buckle) fractures and to determine the need for serial radiographs taken at follow-up visits.

DESIGN:

Retrospective medical record review; survey questionnaire of a panel of experts.

SETTING:

The pediatric emergency department (PED) and the pediatric orthopedic clinic at an urban, tertiary care hospital.

PATIENTS:

All children with torus fractures referred to the pediatric orthopedic clinic for follow-up visits between February 1995 and February 1997.

MAIN OUTCOME MEASURES:

The number of patients whose postcast studies was obtained in the PED; number of follow-up visits and studies conducted at the pediatric orthopedic clinic; usual regional practices as extracted from a panel of experts by survey questionnaire.

RESULTS:

Of 70 patients, 46 (66%) were evaluated by a single, precast study in the PED, and 24 (34%) were evaluated by both precast and postcast studies in the PED. The time range of the first follow-up study was the first to fifth week after the patient's injury. The range of the number of follow-up studies for each patient was 0 to 5. Our cohort's total radiology charges for 70 patients were $27251. Regional directors of pediatric orthopedic surgery unanimously agreed that postcast studies in the PED are unnecessary. The range of the number of follow-up studies they obtained is 0 to 3 per patient.

CONCLUSIONS:

Postcast studies of torus fractures are unnecessary. Multiple radiographs taken during follow-up visits, especially early in the healing process, do not change fracture management. Relying on the clinical examination, perhaps combined with a single follow-up study, is a more appropriate regimen for the management of pediatric torus fractures and translates into a cost savings of over $ 10000 for our 70 patients.

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PMID:
10482206
[PubMed - indexed for MEDLINE]
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