Is Routine Imaging Necessary for the Management of Pediatric Hand Fractures Postoperatively?

Background: Pediatric hand fractures heal remarkedly well, and clinically significant displacement after operative fixation is rare. Radiation exposure in medical practice is regulated by the Ionizing Radiation Medical Exposure Regulations 2017, and unnecessary radiation should be avoided. In the literature, there is paucity of information regarding the number of radiographs required in the postoperative period and guidelines are lacking.

Methods: This study aims to examine whether routine imaging or the lack of it influences functional outcome and time to discharge from the clinic. A retrospective data of pediatric hand fractures requiring intervention between 2014 and 2018 at our institution were conducted before and after elimination of routine postoperative imaging. A total of 230 patients were included in the study.

Results: Two cohorts of patients were identified. The first had routine postoperative radiographs, whereas the second did not have routine radiographs. There was no change in management and difference in the range of motion at discharge between the 2 groups (P = 0.74). Patients without routine imaging were discharged earlier from clinic (74.4 vs 108.2 days, P = 0.012).

Conclusions: This study shows that clinically significant fracture displacement is rare after operative reduction and fixation in pediatric age group. It demonstrates our experience in refraining from routine postoperative radiographs. The overall benefit is to avoid unnecessary radiation and subsequent costs implicated.