![]() All but 5 were followed up in the orthopedic clinic for at least 4 weeks postinjury. All 70 patients were followed up at least once in the orthopedic clinic. Radiology reports confirmed no change in bony alignment at any fracture site after application of the cast. The remaining 24 (34%) underwent both precast and postcast studies in the PED. Forty-six patients (66%) underwent a single, precast study in the PED. Forty-six boys and 24 girls (mean age, 9.2 years) were identified. All fractures were at the distal metaphysis. The survey asked the directors of pediatric orthopedic surgery to describe their facility's management regimen for torus fractures.Īmong patients who visited the PED during the investigation period, we identified 70 who were diagnosed with torus fractures of the radius or ulna. To compare regional management trends with our own, we sent a survey to the directors of pediatric orthopedic surgery at all 7 other accredited programs for residency training in orthopedic surgery (as listed in the 1996-1997 Graduate Medical Education Directory) in New England (Connecticut, Massachusetts, Rhode Island, and Vermont). There was no clinical pathway in place regarding radiography at the time of this investigation. Demographic and clinical data extracted included the age and sex of each patient, fracture site, number of studies obtained in the pediatric emergency department (PED), dates of follow-up visits, clinical condition at follow-up, and whether radiographs were obtained at that clinic visit (a follow-up study). There were no discrepancies between radiologist and surgeon. Radiology reports and orthopedic charts were reviewed together to assure diagnostic agreement. The radiology reports were then reviewed to determine which patients had a torus fracture diagnosis. The medical records were retrieved of all patients who had forearm or wrist studies ordered at the pediatric orthopedic clinic. An attending pediatric orthopedic surgeon staffs the clinic and sees every patient along with orthopedic surgical residents. The pediatric orthopedic clinic primarily serves an urban population. One of us (K.S.F.) performed a retrospective review of x-ray logs to identify patients referred to the pediatric orthopedic clinic between February 1995 and February 1997 at Boston Medical Center in Massachusetts, an urban, tertiary care, academic teaching hospital with an accredited training residency program in orthopedic surgery. Relying on the clinical examination, perhaps combined with a single follow-up study, is a more appropriate regimen for the management of pediatric torus fractures and translates into a cost savings of over $10,000 for our 70 patients. ![]() Multiple radiographs taken during follow-up visits, especially early in the healing process, do not change fracture management. The range of the number of follow-up studies they obtained is 0 to 3 per patient.Ĭonclusions Postcast studies of torus fractures are unnecessary. Regional directors of pediatric orthopedic surgery unanimously agreed that postcast studies in the PED are unnecessary. Our cohort's total radiology charges for 70 patients were $27,251. The range of the number of follow-up studies for each patient was 0 to 5. The time range of the first follow-up study was the first to fifth week after the patient's injury. ![]() Results Of 70 patients, 46 (66%) were evaluated by a single, precast study in the PED, and 24 (34%) were evaluated by both precast and postcast studies in the PED. Main Outcome Measures The number of patients whose postcast studies was obtained in the PED number of follow-up visits and studies conducted at the pediatric orthopedic clinic usual regional practices as extracted from a panel of experts by survey questionnaire. Patients All children with torus fractures referred to the pediatric orthopedic clinic for follow-up visits between February 1995 and February 1997. Setting The pediatric emergency department (PED) and the pediatric orthopedic clinic at an urban, tertiary care hospital. Objectives To assess the utility of radiographs taken immediately after the application of a cast in the management of pediatric torus (or buckle) fractures and to determine the need for serial radiographs taken at follow-up visits.ĭesign Retrospective medical record review survey questionnaire of a panel of experts. Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography.
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