Distal forearm fractures in children:the role of radiographs during follow up.

There is no consensus on the frequency of radiographic examination in the routine follow up of distal forearm fractures in children. This study was undertaken in an attempt to rationalize and optimize the use of ionizing radiation in these circumstances. The radiographs and clinical notes of 325 distal forearm fractures in children were retrospectively studied. Degrees of initial angulation were measured from all of the radiographs performed during follow up. Comparisons of outcome were made between the fractures with initial angulation under 10 degrees and over 10 degrees, types of fracture and the degree of reduction. Fractures with initial angulation of < 10 degrees had no clinically significant evidence of re-angulation and should be considered stable requiring only an initial diagnostic radiograph. Complete fractures, displaced fractures and fractures involving both the radius and ulna require more careful follow up. Residual angulation after manipulation under anaesthetic (MUA) of 5-10 degrees was not associated with an increased rate of re-angulation in this study. There is no apparent advantage in performing more than three radiographs in the majority of cases. The authors make recommendations concerning the optimal frequency of radiography in the follow up of forearm fractures in children.