Klaus Dresing1, Francisco Fernandez2, Peter Schmittenbecher3, Kaya Dresing4, Peter Strohm5, Christopher Spering6, Ralf Kraus7. 1. Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37099, Göttingen, Deutschland. klaus.dresing@med.uni-goettingen.de. 2. Kindertraumatologie, Klinikum Stuttgart Olgahospital, Stuttgart, Deutschland. 3. Kinderchirurgische Klinik, Städtisches Klinikum Karlsruhe, Karlsruhe, Deutschland. 4. Darmstädter Kinderkliniken Prinzessin Margaret, Darmstadt, Deutschland. 5. Klinik für Orthopädie und Unfallchirurgie, Klinikum Bamberg, Bamberg, Deutschland. 6. Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37099, Göttingen, Deutschland. 7. Klinik für Unfallchirurgie und Orthopädie, Klinikum Bad Hersfeld, Bad Hersfeld, Deutschland.
Abstract
The indication for radiographic examinations in pediatric and adolescent trauma patients should follow ALARA (as low as reasonably achievable). Because of the effect of radiation on the growing sensitive tissues of these young patients, a strict indication should always be given for radiation use and during controls after fracture repair. METHODS: An online survey by the Pediatric Traumatology Section (SKT) of the German Trauma Society (DGU) from Nov. 15, 2019, to Feb. 29, 2020, targeting trauma, pediatric, and general surgeons and orthopedic surgeons. RESULTS: Participants: 788. Intraoperative applications: Collimation 50% always, postprocessing for magnification 40%, pulsed x-ray 47%, and 89% no continuous fluoroscopy; 63% osteosynthesis never directly on image intensifier. Radiographic controls after implant removal never used by 24%. After operated supracondylar humerus fracture, controls are performed up to 6 times. After distal radius greenstick fracture, 40% refrain from further X-ray controls, after conservatively treated clavicular shaft fracture, 55% refrain from further controls, others X-ray several times. After nondisplaced conservatively treated tibial shaft fracture, 63% recommend radiographic control after 1 week in two planes, 24% after 2 weeks, 37% after 4 weeks, and 32% after 6 weeks. DISCUSSION: The analysis shows that there is no uniform radiological management of children and adolescents with fractures among the respondents. For some indications for the use of radiography, the benefit does not seem evident. The ALARA principle does not seem to be consistently followed. CONCLUSION: Comparing the documented results of the survey with the consensus results of the SKT, differences are apparent.
The indication for radiographic examinations in pediatric and adolescent trauma patients should follow ALARA (as low as reasonably achievable). Because of the effect of radiation on the growing sensitive tissues of these young patients, a strict indication should always be given for radiation use and during controls after fracture repair. METHODS: An online survey by the Pediatric Traumatology Section (SKT) of the German Trauma Society (DGU) from Nov. 15, 2019, to Feb. 29, 2020, targeting trauma, pediatric, and general surgeons and orthopedic surgeons. RESULTS: Participants: 788. Intraoperative applications: Collimation 50% always, postprocessing for magnification 40%, pulsed x-ray 47%, and 89% no continuous fluoroscopy; 63% osteosynthesis never directly on image intensifier. Radiographic controls after implant removal never used by 24%. After operated supracondylar humerus fracture, controls are performed up to 6 times. After distal radius greenstick fracture, 40% refrain from further X-ray controls, after conservatively treated clavicular shaft fracture, 55% refrain from further controls, others X-ray several times. After nondisplaced conservatively treated tibial shaft fracture, 63% recommend radiographic control after 1 week in two planes, 24% after 2 weeks, 37% after 4 weeks, and 32% after 6 weeks. DISCUSSION: The analysis shows that there is no uniform radiological management of children and adolescents with fractures among the respondents. For some indications for the use of radiography, the benefit does not seem evident. The ALARA principle does not seem to be consistently followed. CONCLUSION: Comparing the documented results of the survey with the consensus results of the SKT, differences are apparent.
Authors: Ming Chien; Blake Bulloch; Pamela Garcia-Filion; Mostafa Youssfi; Michael W Shrader; Lee S Segal Journal: Pediatr Emerg Care Date: 2011-11 Impact factor: 1.454
Authors: Frances M Chaar-Alvarez; Fred Warkentine; Keith Cross; Sandra Herr; Ronald I Paul Journal: Pediatr Emerg Care Date: 2011-11 Impact factor: 1.454
Authors: Seung Woo Baek; Jae Sung Ryu; Cheol Hee Jung; Joo Han Lee; Won Kyoung Kwon; Nam Sik Woo; Hae Kyoung Kim; Jae Hun Kim Journal: Korean J Pain Date: 2013-04-03