Abstract
Purpose: The absence of general guidelines for radiographic follow-ups of pediatric diaphyseal forearm fractures treated with ESIN results in an arbitrary array of X-ray examinations. In most pediatric traumatology departments, an X-ray check is carried out 4 weeks after ESIN osteosynthesis of forearm shaft fractures to detect incipient consolidation of the fracture. However, the elevated sensitivity to ionizing radiation requires special precautions in the pediatric populations. To prevent the indiscriminate use of this diagnostic tool it is necessary to assess the consequence of routinely taken X-rays at the 4-week follow-up.
Methods: This retrospective analysis included 219 pediatric patients who had undergone ESIN treatment for a diaphyseal forearm fracture. They completed their follow-up between 2010 and 2018 at the same level one pediatric trauma center. Binary logistic regression was calculated to identify risk factors that are associated with an increased probability of an abnormal X-ray examination or even a change in the postoperative procedure.
Results: Of the 219 pediatric patients included, 12 (5.5 %) patients had aberrant radiographic findings at the 4-week follow-up. The regression showed that the probability of receiving an abnormal radiograph increased significantly as soon as other non-radiological (p = 0.012, OR 14.554) deviations (nRDs) were found. In the group of nRDs, a positive correlation between irregularities in medical history (n = 59) could be demonstrated (p = 0.003, OR = 8.134). Abnormalities in the physical examination (p = 0.193) did not show this correlation. Confounding factors such as gender (p = 0.403) or the age of the children at the time of fracture (p = 0.141) also had no statistically relevant influence. The presence of an nRD also increases the probability of the postoperative procedure to be modified (p < 0.001).
Conclusion: This study provides clear evidence that standardized radiographic follow-up 4 weeks after surgical treatment has no clinical consequences if the course of the fracture is otherwise uneventful. It should be strictly reserved for pediatric patients with a complicated course.
Level of evidence: Level III