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Is Routine Imaging Necessary for the Management of Pediatric Hand Fractures Postoperatively?
Aseel Sleiwah1, Ahmed Al-Jabir, Maleeha Mughal
1From the Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
Insights
Eliminating routine postoperative radiographs for pediatric hand fractures does not affect healing outcomes. This approach reduces radiation exposure and leads to earlier patient discharge from the clinic.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Medical Imaging
Background:
- Pediatric hand fractures typically heal well with rare clinically significant displacement post-operative fixation.
- Guidelines for postoperative radiography in pediatric hand fractures are lacking, despite radiation exposure regulations.
- Existing literature offers limited information on the necessity of routine postoperative imaging.
Purpose of the Study:
- To evaluate the impact of routine postoperative imaging versus no routine imaging on functional outcomes.
- To determine if eliminating routine radiographs influences the time to clinic discharge for pediatric hand fractures.
- To assess the clinical significance of displacement after operative fixation in pediatric hand fractures.
Main Methods:
- A retrospective study of 230 pediatric hand fractures requiring intervention between 2014 and 2018.
- Comparison of two cohorts: one with routine postoperative radiographs, the other without.
- Analysis of functional outcomes, range of motion, and time to discharge.
Main Results:
- No significant difference in the range of motion at discharge between groups (P = 0.74).
- Patients not receiving routine postoperative radiographs were discharged significantly earlier (74.4 vs 108.2 days, P = 0.012).
- Clinically significant displacement was rare after operative fixation.
Conclusions:
- Routine postoperative radiographs are not necessary for pediatric hand fractures treated operatively.
- Refraining from routine imaging avoids unnecessary radiation exposure and associated costs.
- Eliminating routine imaging can expedite patient discharge without compromising outcomes.
Background:
Pediatric hand fractures heal remarkedly well, and clinically significant displacement after operative fixation is rare. Radiation exposure in medical practice is regulated by the Ionizing Radiation Medical Exposure Regulations 2017, and unnecessary radiation should be avoided. In the literature, there is paucity of information regarding the number of radiographs required in the postoperative period and guidelines are lacking.
Methods:
This study aims to examine whether routine imaging or the lack of it influences functional outcome and time to discharge from the clinic. A retrospective data of pediatric hand fractures requiring intervention between 2014 and 2018 at our institution were conducted before and after elimination of routine postoperative imaging. A total of 230 patients were included in the study.
Results:
Two cohorts of patients were identified. The first had routine postoperative radiographs, whereas the second did not have routine radiographs. There was no change in management and difference in the range of motion at discharge between the 2 groups (P = 0.74). Patients without routine imaging were discharged earlier from clinic (74.4 vs 108.2 days, P = 0.012).
Conclusions:
This study shows that clinically significant fracture displacement is rare after operative reduction and fixation in pediatric age group. It demonstrates our experience in refraining from routine postoperative radiographs. The overall benefit is to avoid unnecessary radiation and subsequent costs implicated.
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