RT Journal
A1 Farbman KS, Vinci RJ, Cranley WR, Creevy WR, Bauchner H
T1 THe role of serial radiographs in the management of pediatric torus fractures
JF Archives of Pediatrics & Adolescent Medicine
JO Archives of Pediatrics & Adolescent Medicine
YR 1999
FD September 1
VO 153
IS 9
SP 923
OP 925
DO 10.1001/archpedi.153.9.923
UL http://dx.doi.org/10.1001/archpedi.153.9.923
AB 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.Design 
    Retrospective medical record review; survey questionnaire of a panel of experts.Setting 
    The pediatric emergency department (PED) and the pediatric orthopedic clinic at an urban, tertiary care hospital.Patients 
    All children with torus fractures referred to the pediatric orthopedic clinic for follow-up visits between February 1995 and February 1997.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.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. The time range of the first follow-up study was the first to fifth week after the patient's injury. The range of the number of follow-up studies for each patient was 0 to 5. Our cohort's total radiology charges for 70 patients were $27,251. Regional directors of pediatric orthopedic surgery unanimously agreed that postcast studies in the PED are unnecessary. The range of the number of follow-up studies they obtained is 0 to 3 per patient.Conclusions 
    Postcast studies of torus fractures are unnecessary. Multiple radiographs taken during follow-up visits, especially early in the healing process, do not change fracture management. 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.