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Pediatr Emerg Care. 2020 Jan 3. doi: 10.1097/PEC.0000000000002042. [Epub ahead of print]

Utility of Postreduction Radiographs After Fluoroscopy-Guided Reduction and Casting of Uncomplicated Pediatric Forearm Fractures.

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1
From the Maimonides Medical Center, Brooklyn, NY.

Abstract

OBJECTIVE:

The aim of the study was to determine efficacy of performing postreduction radiographs in managing uncomplicated pediatric forearm fractures after reduction and casting under fluoroscopic guidance.

DESIGN:

This is retrospective analysis of consecutive cases.

SETTING:

The study was conducted in a large urban hospital pediatric emergency department (ED).

PARTICIPANTS:

Pediatric patients presenting to the ED with a forearm fracture between the ages of 0 to 18 years. All received orthopedic manual reduction with fluoroscopic guidance and casting, then followed by performance of a dedicated 2-view radiographic series of postreduction forearm to document proper alignment and cast placement.

MAIN OUTCOME(S) AND MEASURE(S):

Of 236 consecutive cases studied, there were only 5 cases (2%) in which the managing orthopedist determined that a further reduction attempt was warranted based on the postreduction radiograph results. All were mid-shaft fractures of both radius and ulna, which were angulated and/or displaced. The remaining 231 patients with an uncomplicated forearm fracture received no further ED clinical orthopedic intervention after performing postreduction radiographs. The mean ED time to ultimate discharge was prolonged an average of 89 minutes per patient after reduction and casting while awaiting performance/orthopedic review of postreduction radiographs. A calculation of postreduction radiograph cost amounted to a total of nearly US $50,000.

CONCLUSIONS:

Performance of postreduction radiographs in children with uncomplicated pediatric forearm fractures that are reduced and casted under fluoroscopy has little clinical utility and contributes to increased radiation exposure, patient health care cost, and time spent in the ED. Patients with mid-shaft forearm fractures involving both radius and ulna (especially if angulated or displaced) are at risk for unacceptable reduction after casting and may be the target group in which performing post reduction radiographs has potential benefit.

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