Related Experiment Video
Updated: Apr 7, 2026
Minimally Invasive Treatment for Thoracolumbar Burst Fracture Using Sagittal Alignment Screws and A Trauma Reduction Device
Published on: November 8, 2024
Evaluating the Necessity of Follow-Up Radiographs in Nonoperative Clavicle Fractures in Children Aged 1 to 10 Years
Tessa DeCicco1, Olivia Grande2, Kedan Mack3
1UBMD Orthopaedics and Sports Medicine.
Insights
Routine follow-up x-rays for pediatric clavicle fractures may not be necessary. One follow-up x-ray is sufficient, reducing costs and radiation exposure for children with clavicle fractures.
Area of Science:
- Pediatric Orthopedics
- Radiology
- Evidence-Based Medicine
Background:
- Clavicle fractures are the most common long bone fractures in children.
- Current practice involves 2 follow-up x-rays for nonoperative fractures.
- This study evaluates the necessity of routine follow-up imaging.
Purpose of the Study:
- To assess the rate of management changes after routine follow-up x-rays in pediatric clavicle fractures.
- To determine if follow-up x-rays can be eliminated in standard care.
- To reduce costs and radiation exposure in pediatric fracture management.
Main Methods:
- Retrospective chart review of pediatric clavicle fractures (ages 1-10).
- Included data on demographics, injury details, immobilization, and follow-up imaging.
- Analyzed changes in management and complications.
Main Results:
- 504 fractures were analyzed; 3.2% had management changes, 1.6% had complications.
- Most management changes (13/16) occurred after the first follow-up x-ray.
- No significant increase in complications or management changes for fractures with >2 x-rays.
Conclusions:
- One follow-up x-ray is likely sufficient for nonoperative pediatric clavicle fractures.
- Eliminating unnecessary follow-up x-rays can decrease costs and radiation exposure.
- Clinical judgment remains paramount when deciding on further imaging.
Background:
Clavicle fractures are the most common long bone fracture in the pediatric population. It is common practice to obtain 2 follow-up x-rays around 1 and 3 months postinjury in nonoperative fractures. The goal of this study is to assess the rate of change in management following routine follow-up x-rays and to determine if follow-up x-rays can potentially be eliminated from standard clinical management for pediatric nonoperative clavicle fractures.
Methods:
This is a retrospective chart review that included pediatric (age: 1 to 10 y) clavicle fractures from 4 attending physicians between January 1, 2010 and December 31, 2023 (n=615). Demographics, mechanism of injury, side of injury, time from injury to immobilization, type of fracture, type of immobilization, length of follow-up, and the number of follow-up x-rays were recorded. Patient outcome characteristics noted included pain at the final visit, physical therapy referrals, limited range of motion, changes in management, and complications.
Results:
Five hundred four fractures from 496 patients (62.7% male) were included. The average age was 5.4 years (range: 1 to 10 y). A sling was used most often (63.9%) as immobilization. Average time from injury to discharge from care was 50.2 days (range: 15 to 204 d). During follow-up, 178 (35.3%) fractures had 1 x-ray, 226 (44.8%) fractures had 2, 74 (14.7%) fractures had 3, 19 (3.8%) fractures had 4, and 2 (0.4%) fractures had ≥5 follow-up x-rays. We observed 16 (3.2%) change in management cases and 8 (1.6%) complication cases. Of the 16 changes in management cases, 13 changes followed the first follow-up x-ray, while 3 followed the second. Of the 95 (18.8%) cases that had >2 follow-up x-rays, 2 (2.1%) experienced complications, 3 (3.2%) had a change in management, and 1 (1.1%) had both a complication and a change in management.
Conclusions:
Our results suggest that no more than 1 follow-up x-ray in nonoperative pediatric clavicle fractures is necessary unless otherwise indicated by clinical history and exam. Minimizing follow-up x-rays proves significant in eliminating costs and unnecessary radiation exposure.
Level Of Evidence:
Level IV-case series.
Related Concept Videos
01:27Fractures: Bone Repair
Minor fractures with no bone displacement are treated by immobilizing the fractured bone using a cast or splint. However, in the case of fractures with displaced bones, the broken bones are repositioned before immobilization to ensure successful healing without deformation and loss of function. The realignment of fractured bone ends is performed through a process called reduction. If the...
01:09Changes in the Appendicular Skeleton with Age
Initially, the limb buds consist of a core of mesenchyme covered by a layer of ectoderm. The ectoderm at the end of the limb bud thickens to form a narrow crest called the apical ectodermal ridge. This ridge stimulates the underlying...
01:30Radiological Investigation I: X-ray and CT
01:14Imaging Studies I: CT and MRI
Description of the Procedures
Computed Tomography (CT) scan:
Computed Tomography (CT) scans use X-ray technology to generate detailed images of bones, organs, and tissues. During the scan, the patient lies on a moving table...
01:20Imaging Studies for Cardiovascular System III: X-Ray
Definition and Purpose
An X-ray, or radiograph, is a non-invasive method that uses ionizing radiation to take images of internal structures. It is mainly used in cardiac imaging to examine the heart, lungs, and major blood vessels, aiming to identify abnormalities in the heart's size, shape, and position, such as heart failure, congenital defects, and vascular...