Journal of Pediatric Orthopaedics - 2026-04-06 - Journal Article
Evaluating the Necessity of Follow-Up Radiographs in Nonoperative Clavicle Fractures in Children Aged 1 to 10 Years.
DeCicco T, Grande O, Mack K, Belal K, Pavlesen S, Ferrick M
Topics
Key Takeaway
In nonoperative clavicle fractures in children aged 1–10, only 3.2% required a management change, with 81% of those changes occurring after the first follow-up radiograph, supporting elimination of routine second follow-up imaging.
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Summary
This study asked whether routine second follow-up radiographs alter management in nonoperative clavicle fractures in children aged 1–10. Retrospective review of 504 fractures across 4 surgeons over 13 years recorded management changes and complications at each imaging visit. Only 16 cases (3.2%) had a management change, 13 of which (81%) occurred after the first follow-up radiograph; the second follow-up radiograph drove only 3 changes (0.6% of total cohort).
Key Limitation
The retrospective design cannot exclude that additional radiographs were selectively ordered for clinically suspicious cases, meaning the true yield of a protocolized second radiograph in an unselected population may differ from what this data reflects.
Original Abstract
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.