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Utility of Follow-up Radiographs in Type 1 Supracondylar Humerus Fractures
Shrey Nihalani1, Adele Bloodworth, Katie Frith
1Department of Orthopaedic Surgery, Children's Hospital of Alabama, University of Alabama at Birmingham, Birmingham, AL.
Insights
Follow-up X-rays for pediatric type 1 supracondylar humerus (SCH) fractures are not clinically necessary and incur significant costs. Eliminating these radiographs can reduce expenses and radiation exposure without impacting patient care.
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.
Objective:
Supracondylar humerus (SCH) fractures are common among pediatric patients, with the severity categorized using the Gartland classification system. Type 1 SCH fractures are nondisplaced and treated with immobilization, while more displaced fractures require surgery. The need for follow-up radiographs, particularly for type 1 fractures, is an area where evidence is lacking. This study investigates the clinical value and financial implications of follow-up radiographs for type 1 SCH fractures, hypothesizing that they do not alter clinical management and, therefore, represent an unnecessary expense.
Methods:
This retrospective cohort study, approved by the Institutional Review Board, focused on patients under 18 with nondisplaced SCH fractures treated nonoperatively. One hundred one type 1 SCH fractures, in which the fracture was visible on presenting radiographs, were chosen from patients presenting between January 2021 and December 2022. Charts were reviewed for demographic information, time of cast removal, and complications. A pediatric orthopaedic surgeon and orthopaedic resident reviewed the radiographs to confirm the injury to be a type 1 SCH fracture.
Results:
Among the 101 patients, after the initial presentation, 79 attended an interim visit and 101 attended a "3-week follow-up" at an average of 23 days postinjury. All patients underwent radiographs during these visits for a total of 180 radiographs after confirmation of type 1 SCH fracture. No changes in management resulted from follow-up radiographs. One instance of refracture was noted ~3 months after cast removal. There were 180 superfluous follow-up radiographs taken at subsequent clinic visits. The total charge for these radiographs was $76,001.40, averaging $752.49 per patient.
Conclusion:
Follow-up radiographs for type 1 SCH fractures did not lead to changes in clinical management, aligning with previous findings in more severe SCH fractures. This approach can reduce costs, radiation exposure, and clinic time without compromising patient care. The study can reassure providers and parents about the lack of necessity for follow-up radiographs to document healing.
Level Of Evidence:
Level-IV.
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