Utility of Follow-up Radiographs in Type 1 Supracondylar Humerus Fractures

Area of Science:

• Orthopaedic Surgery
• Pediatric Orthopaedics
• Radiology

Background:

• Supracondylar humerus (SCH) fractures are common in children, with Gartland classification grading severity.
• Type 1 SCH fractures are nondisplaced and typically managed nonoperatively with immobilization.
• Evidence supporting the clinical value of routine follow-up radiographs for type 1 SCH fractures is limited.

Purpose of the Study:

• To evaluate the clinical utility of follow-up radiographs in pediatric type 1 SCH fractures.
• To assess the financial implications of routine follow-up imaging for these fractures.
• To determine if follow-up radiographs alter clinical management or patient outcomes.

Main Methods:

• Retrospective cohort study of 101 pediatric patients with type 1 SCH fractures treated nonoperatively.
• Review of medical charts and radiographs to confirm fracture type and assess management changes.
• Analysis of follow-up visit data, including radiographs taken and associated costs.

Main Results:

• No changes in clinical management occurred due to follow-up radiographs in any of the 101 patients.
• 180 follow-up radiographs were deemed superfluous, costing $76,001.40 ($752.49 per patient).
• One instance of refracture occurred approximately 3 months after cast removal, unrelated to follow-up imaging.

Conclusions:

• Follow-up radiographs for type 1 SCH fractures do not alter clinical management and are not necessary for documenting healing.
• Discontinuing routine follow-up radiographs can decrease healthcare costs, radiation exposure, and clinic time.
• This evidence supports a shift in practice, reassuring providers and parents about omitting routine follow-up imaging.