Distal forearm fractures in children: the role of radiographs during follow up

Abstract Background Distal forearm fractures are the most common fractures in childhood and can be diagnosed with ultrasound. The aim of this study was to demonstrate the eligibility of Wrist SAFE for clinical use and the avoidance of X-ray application in children. Methods We enrolled patients from 0 – 12 years with suspected distal forearm fractures. They were treated according to the Wrist SAFE algorithm, a detailed pathway for ultrasound fracture diagnosis, treatment decisions and control options. Additionally, 9 clinical predictors were tested. Depending on sonographic and clinical findings, patients were treated with functional movement, immobilization or surgery. Follow-up was conducted after 5 days and 3 months. Results 16 physicians (6 specialists, 10 assistants) at 5 study sites examined 498 (234 boys, 251 girls, 13 not specified) patients with ultrasound, age 8.4 (0 – 12) years. 321 (64 %) patients were diagnosed with a fracture, 5 (0.8 %) with suspected fracture; X-rays were conducted in 58 cases (12 %), 9 (1.8 %) of them on day 1 and 49 (9.8 %) on day 5; sonographic diagnosis was confirmed in 57 of 58 (98 %) cases; in one case, the sonographic diagnosis of “contusion” was revised to “radius fracture”. 381 patients (77 %) underwent final follow-up after an average of 96 (62 – 180) days. All patients were symptom-free at that time. Palpatory bone pain over the radius/ulna and swelling were identified as clinical predictors. 81 % of X-rays were avoided. Conclusion Wrist SAFE enables the safe diagnosis and therapy of distal forearm fractures in children. Findings can be reviewed safely, also enabling physicians in training to use the method. 81 % of X-rays can be avoided, a figure that corresponds to 2.8 million X-rays in the G10 member states. After performing 100 examinations, physician have acquired the necessary sonography skills.

Download Full-text

X-ray Follow-up after Open Reduction Internal Fixation of Distal Forearm Fracture

Journal of Wrist Surgery ◽

10.1055/s-0040-1721139 ◽

2020 ◽

Author(s):

Henrik Johan Sjølander ◽

Sune Jauffred ◽

Michael Brix ◽

Per H. Gundtoft

Keyword(s):

Diagnostic Imaging ◽

Forearm Fracture ◽

Minimal Risk ◽

Distal Forearm ◽

Forearm Fractures ◽

Distal Forearm Fracture ◽

Standard Regimen ◽

Prolonged Immobilization ◽

Distal Forearm Fractures

Abstract Background Following surgery, the standard regimen for fractures of the distal forearm includes radiographs taken 2-weeks postoperatively. However, it is unclear whether these radiographs have any therapeutic risks or benefits for patients. Objective The purpose of this study is to determine the importance of radiographs taken 2-weeks after surgery on distal forearm fractures, especially if it leads to further operations, and to establish whether this practice should be continued. Materials and Methods This is a retrospective cohort study of patients with a distal forearm fracture treated surgically with a volar locking plate at two university hospitals in Denmark. Standard aftercare at both departments is 2 weeks in a cast. Patients attend a 2-week follow-up, at which the cast is replaced with a removable orthosis and radiographs are taken. It was recorded whether these radiographs had resulted in any change of treatment in terms of further operations, prolonged immobilization, additional clinical follow-up, or additional diagnostic imaging. Results A total of 613 patients were included in the study. The radiographs led to a change of standard treatment for 3.1% of the patients. A second operation was required by 1.0%; 0.5% were treated with prolonged immobilization, and 1.6% had additional outpatient follow-up due to the findings on the radiographs. Additional diagnostic imaging was performed on 1.9% of the patients. Conclusion The radiographs taken at the 2-weeks follow-up resulted in a change of treatment in 3.1% of the cases. Given the low cost and minimal risk of radiographs of an extremity, we concluded that the benefits outweigh the costs of routine radiographs taken 2 weeks after surgical treatment of distal forearm fractures.

Download Full-text

Plaster cast treatment for distal forearm fractures in children

Journal of Pediatric Orthopaedics B ◽

10.1097/bpb.0000000000000678 ◽

2020 ◽

Vol 29 (2) ◽

pp. 179-186

Author(s):

Domenico Ravier ◽

Ilaria Morelli ◽

Valentina Buscarino ◽

Chiara Mattiuz ◽

Luca M. Sconfienza ◽

...

Keyword(s):

Plaster Cast ◽

Distal Forearm ◽

Forearm Fractures ◽

Fractures In Children ◽

Distal Forearm Fractures

Download Full-text

Reply to “Displaced distal forearm fractures in children with an indication for reduction under general anesthesia should be percutaneously fixated” by van Egmond PW, Schipper IB, van Luijt PA in Eur J Orthop Surg Traumatol. 2012 Apr;22(3):201–207

European Journal of Orthopaedic Surgery & Traumatology ◽

10.1007/s00590-012-1003-2 ◽

2012 ◽

Vol 22 (6) ◽

pp. 527-527

Author(s):

Georg Singer ◽

Tanja Peschaut ◽

Tanja Kraus ◽

Robert Eberl

Keyword(s):

General Anesthesia ◽

Distal Forearm ◽

Forearm Fractures ◽

Fractures In Children ◽

Distal Forearm Fractures

Download Full-text

Point-of-care ultrasound compared with conventional radiographic evaluation in children with suspected distal forearm fractures in the Netherlands: a diagnostic accuracy study

Emergency Medicine Journal ◽

10.1136/emermed-2018-208380 ◽

2019 ◽

Vol 36 (10) ◽

pp. 613-616 ◽

Cited By ~ 3

Author(s):

Anniek C Epema ◽

Mariëlle J B Spanjer ◽

Lieselotte Ras ◽

Johannes C Kelder ◽

Marieke Sanders

Keyword(s):

The Netherlands ◽

Diagnostic Accuracy ◽

Conventional Radiography ◽

Point Of Care Ultrasound ◽

Distal Forearm ◽

Forearm Fractures ◽

Predictive Values ◽

Pain Scores ◽

Fractures In Children ◽

Distal Forearm Fractures

BackgroundDistal forearm fractures are common in children. The reference standard to diagnose these fractures is by conventional radiography, which exposes these patients to harmful radiation. Ultrasound (US) seems to be a good alternative. However, emergency physicians (EPs) in the Netherlands have limited experience in using US for diagnosing fractures in children.ObjectiveThe primary objective was to determine the accuracy of US, performed by a Dutch EP, compared with conventional radiography, in diagnosing distal forearm fractures in children. As a secondary objective, differences in pain scores during the performance of both US and plain radiography were determined.MethodsChildren, aged between 0 and 14 years old, suspected of having a distal forearm fracture were enrolled at the Emergency Department. US and radiographic findings were compared. Statistics for accuracy were calculated. Pain scores were recorded during US and radiography and compared as well. All participating operators received an hour-long pretrial training.Results100 patients were enrolled. The mean age was 9.5 years (SD, 3.6), and 50% were women. Overall diagnostic accuracy was 92% (95% CI 85%-96%). The sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratios for US were 95% (95% CI 87% to 99%), 86% (95% CI 71% to 95%), 92% (95% CI 83% to 97%), 91% (95% CI 76% to 98%), 6.86 (95% CI 3.04 to 15.51) and 0.05 (95% CI 0.02 to 0.17), respectively. The pain scores during US and radiographic imaging were 3.3 and 4.6, respectively (p<0.01).ConclusionsIn this study, we showed that US is an accurate method for diagnosing distal forearm fractures in children. The main advantages are that it is radiation-free and rapidly practicable, and that patients experience it as less painful than radiography. Moreover, this study has proven that with minimal experience in US, good diagnostic accuracy can be achieved after brief training.

Download Full-text