Does early radiography alter remanipulation rates in paediatric forearm fractures?

In paediatric patients with a forearm fracture, treated with manipulation under anaesthesia with fluoroscopic guidance, protocol varies whether a day 1 post-operative radiograph is performed. The primary aim of this study is to evaluate whether this investigation changes the management of a patient. Secondary aims evaluated number of reinterventions and factors associated with loss of position.

A retrospective study design was used. Cases were identified from the Wellington Regional Hospital radiology database between 1 January 2010 and 30 July 2011. Ethical approval was obtained for this study.

During the study period, 148 patients under 18 years old presented with a forearm fracture; after exclusion criteria were applied, 107 fractures were included. Sixty-five fractures were evaluated with a day 1 post-operative radiograph; no reinterventions were performed as a result of this investigation. Evaluating the total study population (107), only four reinterventions were performed. No reintervention was performed earlier than 1 week. All patients who required reintervention were investigated with a day 1 post-operative radiograph. No statistically significant associations were found between patient demographic, injury or treatment factors and need for reintervention (at any stage).

The day 1 post-operative radiograph does not influence management, and cannot be justified given the further cost for hospitals, unnecessary radiation and additional time required.