Journal of Pediatric Orthopaedics - 2026-05-08 - Journal Article
Are Routine 4-Week Radiographs After ESIN Osteosynthesis in Pediatric Forearm Fractures Necessary?: A Retrospective Analysis and Proposal of a Risk-Adapted Algorithm.
Mojica Crespo R, Memmel C, Hundhausen L, Wulbrand C, Hanke A
Topics
Key Takeaway
Among 553 pediatric ESIN forearm fracture patients, 0 of 362 asymptomatic patients at 4-week follow-up had relevant radiologic findings, supporting elimination of routine radiographs in this subgroup.
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Summary
This study evaluated whether routine 4-week radiographs after ESIN for pediatric diaphyseal forearm fractures yield actionable findings. Of 553 patients (mean age 8.0 years), 65.5% were asymptomatic at 4 weeks; radiologic abnormalities occurred in only 1.3% overall and in zero asymptomatic patients. On multivariable logistic regression, radiologic abnormality was the sole independent predictor of therapeutic consequence (aOR 11.9, 95% CI 2.3–62.3).
Key Limitation
Single-center retrospective design with no standardized definition of 'asymptomatic' documented prospectively, risking inconsistent clinical assessment across providers over the 10-year period.
Original Abstract
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 χ2 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.