Clinical consequence of the 4-week X-ray control after ESIN osteosynthesis of forearm fractures in children

The absence of evidence based 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.

This retrospective analysis included 219 pediatric patients who underwent ESIN treatment for a diaphyseal forearm fracture between 2010 and 2018 at the same pediatric trauma center. The primary outcome was defined as the prevalence of aberrant radiographic findings (ARF) during the 4-week follow-up with an otherwise normal clinical course and examination. Pathologies in the physical exam and irregularities in the medical history were summarized as non-radiological abnormalities (nRD). Binary logistic regression was calculated to identify risk factors associated with an increased likelihood of an ARF.

Of the 219 pediatric patients included, 123 patients had no nRDs at the 4-week follow-up. Only one patient was found to have an ARF (absolute risk = 0.008). Regression showed that the odds of receiving an ARF increased significantly as other nRDs were detected (p = 0.012, OR 14.554). A positive correlation was found especially for irregularities in the medical history (n = 59, p = 0.003, OR = 8.134).

This study provides 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.