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Are Routine 4-Week Radiographs After ESIN Osteosynthesis in Pediatric Forearm Fractures Necessary?: A Retrospective
Roland Mojica Crespo1,2, Clemens Memmel1,2, Lino Hundhausen1,2
1Department of Pediatric Surgery and Pediatric Orthopedics, Clinic St. Hedwig, Barmherzige Brueder Regensburg, KUNO Pediatric University Medical Center.
Insights
Routine 4-week X-rays after pediatric forearm fracture fixation with elastic stable intramedullary nailing (ESIN) are not beneficial for asymptomatic children. This study suggests a risk-adapted follow-up protocol is needed to optimize care.
Area of Science:
- Pediatric Orthopedics
- Trauma Surgery
- Medical Imaging
Background:
- Elastic stable intramedullary nailing (ESIN) is a standard treatment for unstable pediatric forearm fractures.
- Routine 4-week radiographic follow-up is common but its clinical value is uncertain.
- This study investigates the necessity of routine 4-week radiographs and proposes a risk-adapted protocol.
Purpose of the Study:
- To assess the clinical relevance of routine 4-week radiographs in pediatric forearm fractures treated with ESIN.
- To determine if asymptomatic children benefit from 4-week radiographic follow-up.
- To develop a risk-adapted follow-up strategy for these patients.
Main Methods:
- Retrospective analysis of 553 pediatric patients (0-18 years) treated with ESIN for diaphyseal forearm fractures.
- Evaluation of clinical and radiologic findings at 4-week follow-up.
- Statistical analysis including logistic regression to identify predictors of therapeutic consequences.
Main Results:
- 65.5% of patients were asymptomatic at 4 weeks.
- Radiographic abnormalities were infrequent (1.3%) and absent in asymptomatic children.
- Clinical abnormalities were associated with a higher incidence of radiologic findings (2.6% vs. 1.1%).
Conclusions:
- Routine 4-week radiographs do not yield therapeutic consequences in asymptomatic pediatric forearm fracture patients treated with ESIN.
- A risk-adapted X-ray protocol is proposed, requiring further prospective validation.
- Clinical assessment is crucial for guiding follow-up decisions.
Background:
Elastic stable intramedullary nailing (ESIN) is an established treatment for unstable pediatric forearm fractures. Although routine radiographic follow-up at 4 weeks is widely performed, its clinical benefit is unclear. This study aimed to evaluate the relevance of routine 4-week radiographs and to develop a risk-adapted follow-up protocol.
Methods:
We retrospectively analyzed all patients aged 0 to 18 years treated with ESIN for diaphyseal forearm fractures at a level I trauma center between 2014 and 2024. Clinical and radiologic findings at the scheduled 4-week follow-up visit were assessed retrospectively. Radiologic abnormalities were defined as secondary displacement, implant-related problems, or signs of infection. Therapeutic consequences were recorded. Statistical analyses included χ 2 or Fisher exact tests, Mann-Whitney U tests, and logistic regression.
Results:
Of 610 patients screened, 553 were included (mean age: 8.0±3.5 y, 61.1% male). At the 4-week follow-up, 65.5% (362/553) were asymptomatic. Radiologic abnormalities were rare (1.3%, n=7). Importantly, none of the 362 asymptomatic patients showed relevant radiologic findings. Radiologic abnormalities were more frequent in children with clinical abnormalities (2.6% vs. 1.1%). In multivariable analysis, radiologic abnormalities remained the only independent predictor of therapeutic consequences (aOR: 11.9, 95% CI: 2.3-62.3; P =0.003).
Conclusion:
Routine 4-week radiographs after ESIN osteosynthesis in pediatric forearm fractures do not lead to therapeutic consequences in asymptomatic patients. An algorithm for risk-adapted x-ray is proposed, although further prospective evaluation is needed.
Levels Of Evidence:
Level III-retrospective cohort study.
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