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

Abstract

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.

Is there benefit to concurrent x‐ray imaging of the wrist, forearm and elbow in paediatric patients following a fall on the outstretched hand?

“…Despite being an anecdotally accepted practice across several Australian public hospitals, there is no literature to support dedicated concurrent imaging protocols of the paediatric upper limb following trauma. A single comparable study conducted in the United States by Golding et.al 6 of the elbow joint found a second injury proximal to the known wrist fracture was present in 3% (n = 4) of the children, all of whom exhibited physical findings of pain at the elbow. No fractures were documented in children with a negative physical clinical assessment of the elbow joint.…”

“…3,4 The incidence of distal forearm fractures has risen over the past 40 years with some studies suggesting this increase to be a result of a combination of growing sports involvement and increased body weight. 5,6 The typical mechanism of injury is a fall on the outstretched hand (FOOSH), with fractures most commonly occurring in the distal third of the forearm (75%) and involving either or both the radius and ulna. 3 Following a FOOSH, co-occurring injuries of the affected upper limb have been reported in children and include the elbow, hand and shoulder girdle.…”

“…3 Following a FOOSH, co-occurring injuries of the affected upper limb have been reported in children and include the elbow, hand and shoulder girdle. 6,7 The most common co-occurring injury for paediatric patients with a forearm fracture is that of a supracondylar fracture of the distal humerus, reported in up to 5% of cases. 7 The This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.…”

“…The most common type of fractures in the paediatric population involve the radius and ulna (40%–50%) 3,4 . The incidence of distal forearm fractures has risen over the past 40 years with some studies suggesting this increase to be a result of a combination of growing sports involvement and increased body weight 5,6 . The typical mechanism of injury is a fall on the outstretched hand (FOOSH), with fractures most commonly occurring in the distal third of the forearm (75%) and involving either or both the radius and ulna 3 …”

Identifying Risk Factors for Elbow Injury in Children Presenting to the Emergency Department With Distal Forearm Fractures

“…One recent retrospective chart review from a pediatric ED noted the incidence of elbow injury to be less than 3% in this population, with all of the affected children having physical examination findings that localized to the elbow, such as tenderness or inability to move the arm. 4 The current study was performed using the 2011 National Emergency Department Sample (NEDS), in an attempt to further characterize the rate and predictors of co-fracture in a nationally representative sample of children. The NEDS is the largest publicly available ED data set in the United States and has not, to our knowledge, been used to examine the clinical questions raised previously.…”