Routine radiographic follow-up is not necessary after physeal fractures of the distal tibia in children

Abstract

Background and purpose — Unnecessary radiographic and clinical follow-ups are common in treatment of pediatric fractures. We hypothesized that follow-up radiographs are unnecessary to monitor union of physeal fractures of the distal tibia.Patients and methods — All 224 (147 boys) children under 16 years old treated for a physeal fracture of the distal tibia during a 5-year period (2010–14) in Helsinki Children’s Hospital were included in this study. Peterson type II fractures comprised 55% and transitional fractures (Tillaux and Triplane) 20% of all injuries. Fracture displacement and alignment was measured. Type and place of treatment was recorded. Number of follow-up radiographs and outpatient visits was calculated and their clinical significance was assessed.Results — 109 children had fractures with < 2 mm displacement and no angulation. The other 115 children’s mean fracture displacement was 6 mm (2–28). 54% of all children were treated by casting in situ in the emergency room, 20% with manipulation under anesthesia and 26% with surgery (internal 57, external fixation 2). Median 3 (1–7) follow-up appointments and median 3 (0–6) radiographs were taken. Follow-up radiographs at or before cast removal did not alter treatment in any of the patients. 223 patients’ fractures healed within 4–9 weeks in good alignment (≤ 5° angulation).Interpretation — Routine radiographic follow-up is unnecessary to monitor alignment and union of physeal fractures of the distal tibia.

Characterizing and quantifying low-value diagnostic imaging internationally: a scoping review

“…Additionally, we report the extent of low-value imaging. Our additional findings merit further investigation, including chest X-ray after invasive lung procedures such as CVC placement, chest tube placement/removal, biopsies, and other procedures [ 94 – 112 , 339 – 341 ], musculoskeletal follow-ups after fractures or invasive procedures, MRI and X-ray in atraumatic shoulder or upper-extremity pain [ 138 , 139 , 151 – 156 , 160 – 167 , 169 , 173 , 323 – 329 , 334 , 336 ] and staging and follow-up procedures in cancers other than breast, cervical, prostate, and lymphoma [ 58 , 172 , 199 , 202 , 203 , 209 , 235 – 237 , 239 – 241 , 243 – 245 , 247 – 249 ]. Hence, while we confirm previous findings, we also add new findings to the literature.…”

Incidence of growth disturbance after distal tibia physeal fracture in children

“…Therefore, follow-ups should be extended to near skeletal maturity. However, Stenroos et al [ 19 ] suggested that routine radiographic follow-up is unnecessary after physeal fractures of the distal tibia in children. We believe this study will significantly improve prognosis in children after distal tibia physeal fractures.…”

Routine follow-up is unnecessary after intramedullary fixation of trochanteric femoral fractures—Analysis of 995 cases

“…Similar results have been reported for several other fractures. Ovaska [6] and Stenroos [9] have questioned the role of early radiographs among adult and pediatric patients with ankle fractures.…”