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Are Unnecessary Serial Radiographs Being Ordered in Children with Distal Radius Buckle Fractures?

Are Unnecessary Serial Radiographs Being Ordered in Children with Distal Radius Buckle Fractures? Hindawi Radiology Research and Practice Volume 2018, Article ID 5143639, 4 pages https://doi.org/10.1155/2018/5143639 Research Article Are Unnecessary Serial Radiographs Being Ordered in Children with Distal Radius Buckle Fractures? 1,2 1,2 Shi-Neng James Ling and Aidan J. Cleary Department ofOrthopaedics,LoganHospital,Meadowbrook,QLD,Australia Department of Orthopaedics, Redlands Hospital, Cleveland, QLD, Australia Correspondence should be addressed to Shi-Neng James Ling; jamesling9@hotmail.com Received 24 September 2017; Revised 17 December 2017; Accepted 15 January 2018; Published 1 March 2018 Academic Editor: Ali Guermazi Copyright © 2018 Shi-Neng James Ling and Aidan J. Cleary. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. Torus or buckle distal radius fractures are common injuries in the pediatric population. By definition, they are stable and can be treated conservatively with a wrist splint or soft crepe bandage. Objective. eTh objectiveofthisstudy wastoevaluatethe utility of serial radiographs in the clinical outcome of children with stable distal radius buckle fractures. Materials and Methods. A one-month retrospective analysis was undertaken at two major hospitals in Queensland—Logan and Redlands Hospital. Statistical analysis was performed to identify any relationships between serial radiographs and certain demographic parameters including fracture characteristics, age, sex, and limb side. Results. Of the 136 patients, 50% had more than one radiograph series taken. A total of 576 single radiographs and 251 radiograph series were taken. All fractures healed without complications and did not require active intervention. er Th e was a statistically significant relationship ( 𝑝=0.0015) between fracture angulation and multiple radiographs series. A cost analysis revealed $55,890 per year could be saved by not performing serial radiographs. Conclusion. Serial radiographs did not appear to change the excellent clinical outcome for children with distal radius buckle fractures. There is a potential to reduce costs and prevent unnecessary ionizing radiation exposure to children. 1. Introduction 2. Materials and Method Pediatric patients with a distal radius buckle or torus fracture Ethics approval for the study was obtained from Metro South are a common presentation to hospitals [1]. A torus or buckle Ethics Committee, approval number HREC/16/QPAH/543. A fracture is den fi ed as a compression failure of the bone, retrospective, multicentre review of all stable buckle distal usually at the metaphyseal and diaphyseal junction of the radius fractures in patients aged 0–16 was undertaken. All distal radius. eTh y are undisplaced but may be angulated [2]. cases which presented to the Logan and Redlands Hospital, These injuries have little to no tendency to displace and thus Queensland, Australia, over a one-month period from the 1st do not require active intervention. Most standard guidelines of February 2016 to the 1st of March 2016 were identified. recommend treatment with immobilisation in a cast, splint, Both Logan and Redlands Hospital are two major public or soft crepe bandage through their primary care physician metropolitan hospitals accepting all pediatric traumas [9]. All [3–7]. Currently, there is no consensus on the timing and cases of distal radius fractures presenting to the emergency frequency of radiographs in the follow-up of these injuries department were identified through the hospital’s coding in Australian Hospitals. As a result, unnecessary radiographs system. Computed radiographs were used in both locations. may be ordered, exposing children to potentially damaging Both authors individually reviewed all radiographs to identify levels of ionizing radiation [8]. Reducing radiographs would patients who had a buckle fracture that was undisplaced and also reduce costs and resources for the health system. u Th s, either not angulated or angulated less than 10 degrees (see the aim of this study was to assess the utility and frequency Figure 1). of serial radiographs in the management of stable pediatric To ensure diagnostic accuracy, the radiologist report was buckle distal radius fractures. concurrently reviewed with no discrepancies found. Data was 2 Radiology Research and Practice Stable buckle fracture (<10 degrees of Stable buckle fracture, no angulation angulation) Figure 1: Angulated and nonangulated buckle fractures. Table 1: Patient demographics. or active intervention. No re-presentations or complications were identiefi dwithinatleasta6-month time frame. Total number of patients 136 An analysis was performed to identify factors which were Mean age (years) 9 associated with a patient receiving multiple radiograph series Age range 0–16 (Table 3). er Th e was a statistically significant association Sex (male/female) 83/53 between fracture angulation and a patient having multiple Side (left/right) 83/53 radiograph series (𝑝 = 0.0021). eTh re were no signicfi ant Nonangulated/angulated 95/41 associations with age, limb, side, and gender. An extra 115 radiograph series were ordered on top of the 136 series that were performed for initial diagnosis. eTh collected from the clinical records of all patients with regard Australian Medicare Benefits Schedule of 2014 reports a fee to their demographics, type of fracture, clinical outcome, and of $40.50 for wrist radiographs(15).This equatestoasaving number of radiographs and radiograph series. “Radiographic of $4657.50 over the audit period, which translates to a series” was defined as an individual episode of radiograph potential cost saving of approximately $55,890 between the images taken, accompanied by an official request form com- two hospitals per year. pleted by a medical practitioner. It usually consists of at least two views including anterior-posterior (AP) projection and 4. Discussion a lateral projection and occasionally an oblique view. eTh information was recorded on an electronic spreadsheet. Cases eTh re are currently no national guidelines for the use of were excluded if they did not meet the definition of a stable radiographs in managing pediatric buckle fractures. In our buckle fracutre or had images not loaded onto the hospital study, all patients healed without complication, regardless of imaging system or if the clinical record was incomplete. An whether follow-up radiographs were ordered. This excellent analysis was performed using Stata 12 (Statacorp, Texas) to healing rate has been confirmed in multiple studies with identify any relationships between different variables. eTh patients almost always returning to a full level of function chi-squared and Fisher’s exact test were used for correlation with no ongoing deficit [10–12]. Performing serial radio- between categorical variables and the𝑡-test was for corre- graphs for these injuries thus appear to be unnecessary and lation between continuous variables. A 𝑝 value of <0.05 did not change clinical management. was considered statistically significant with a 95% confidence We acknowledge that there may be some perceived interval applied. A cost analysis was also performed using benefits for ordering serial radiographs for buckle fractures. information from the Logan Hospital Radiology Department With medico-legal issues becoming more intertwined in and the Australian Government Medicare Benefits Schedule the clinical management of patients, confirming radiological (MBS). union may provide added protection for the clinician. This information would also be useful when communicating with 3. Results the child’s guardian or carer, which can be dicffi ult at the best of times. One hundred and thirty-six patients with a buckle or torus Our analysis identified that fracture angulation was asso- fracture were included in the study whose demographics are ciated with a higher likelihood of repeat radiographic series. shown in Table 1. The hypothesised causes of this effect are likely multifactorial. Radiograph demographics are shown in Table 2. Half of We believethatthereisaninnate attitude ofthetreating the patients received multiple radiograph series during their clinicians to continue to monitor fractures that are not treatment course. perfectly anatomical, despite the evidence clearly showing All of the 136 fractures were clinically healed as per the that the natural history of this type of fracture is the same medical record without the need for any fracture reduction as that of a nonangulated fracture. This may represent a lack Radiology Research and Practice 3 Table 2: Radiograph demographics. Mean number of Total wrist Mean number of Patients with single Patients with multiple Total number of radiograph radiographs radiographs/patient radiograph series radiograph series radiograph series series/patient 576 4.24 68 68 251 1.85 Table 3: Correlation of factors related to a patient receiving multiple 5. Conclusion radiograph series. In our cohort of patients, buckle fractures angulated less than 10 degrees went on to heal without active medical Factor Single series Multiple series 𝑝 value intervention. This indicates that follow-up radiographs may Side be unnecessary in the clinical management of these injuries. Left 39 44 𝑝=0.3793 In our practice, we only perform a follow-up radiograph if Right 29 24 the patient has clinical evidence of delayed union or a gross Sex anatomical deformity. Male 38 45 𝑝=0.2184 Female 30 23 Disclosure Age Six and under 23 14 This research has been presented in part at the Royal Aus- 𝑝=0.0829 Over 6 45 54 tralian and New Zealand College of Radiologists 68th Annual Displacement Scientific Meeting. No angulation 56 39 𝑝=0.0015 Angulated 12 29 Conflicts of Interest eTh authors declare they have no conflicts of interest regard- ing the publication of this paper. of adequate education for medical staff and an area that could be easily addressed. References It was interesting to note that there was a correlation, however not statistically significant, between the age of a [1] K. W. Nellans, E. Kowalski, and K. C. Chung, “eTh epidemiol- patient and the likelihood of serial radiograph series. Age ogy of distal radius fractures,” Hand Clinics,vol.28, no.2,pp. may play a role in the number of radiograph series per- 113–125, 2012. formed for multiple reasons. eTh re is an increased potential [2] J. S. Davidson, D. J. Brown, S. N. Barnes, and C. E. Bruce, of remodelling for fractures at younger ages. Also, parent “Simple treatment for torus fractures of the distal radius,” The Journal of Bone & Joint Surgery,vol.83, no.8,pp. 1173–1175. expectations may be different for younger patients as opposed [3] A.C.Plint,J.J.Perry,R.Correll,I.Gaboury,and L. Lawton, to older patients and this may influence the doctor’s decision “A randomized, controlled trial of removable splinting versus to perform serial radiographs. casting for wrist buckle fractures in children,” Pediatrics,vol.117, The ALARA or “as low as reasonably achievable” prin- no.3,pp. 691–697, 2006. ciple is designed to minimize radiation exposure. Particu- [4] K.S.Khan,A.Grueff rty,O.Gallagher,D.P.Moore,E.Fogarty, larly in the pediatric population, it is important to attempt andF.Dowling,“Arandomizedtrialof’softcast’fordistalradius to reduce exposure as they are more vulnerable to the buckle fractures in children,” Acta Orthopaedica Belgica,vol.73, effects of ionizing radiation [8]. A child is exposed to no.5,pp. 594–597, 2007. an estimated radiation dose of 0.05–0.005 mSv per sin- [5] A.C.Plint,J.J.Perry,andJ.L. Y.Tsang, “Pediatricwristbuckle gle limb radiograph [13]. Although this dose is almost fractures: Should we just splint and go?” Canadian Journal of negligible in increasing the risk of cancer, the principle Emergency Medicine, vol. 6, no. 6, pp. 397–401, 2004. of minimizing radiation exposure remains important. This [6] E.Koelink,S.Schuh,A.Howard, J. Stimec,L.Barra,and study has found practical and simple ways to achieve this. K. Boutis, “Primary care physician follow-up of distal radius buckle fractures,” Pediatrics,vol.137,no. 1,ArticleIDe20152262, Further, the potential cost savings of limiting serial radio- graphs is significant. In a budget conscious health system, [7] S. West, J. Andrews, A. Bebbington, O. Ennis, and P. Alderman, the$55,890peryearcould bespentinother areasof “Buckle fractures of the distal radius are safely treated in a need. soft bandage: A randomized prospective trial of bandage versus This retrospective study was limited by its small sample plaster cast,” Journal of Pediatric Orthopaedics,vol.25, no.3,pp. size. Other limitations included not knowing the full indi- 322–325, 2005. cations for why the clinician ordered the serial radiograph. [8] A. Magistrellli, “eTh radioprotection of the child in emergency Further qualitative research could focus on the reasons radiology,” in Imaging Non-traumatic Abdominal Emergencies behind this, in an attempt to change clinical practice in order in Pediatric Patients,V.Miele andM.Trinci,Eds.,pp. 377–395, to reduce unnecessary radiographs. Cham: Springer International Publishing, 2016. 4 Radiology Research and Practice [9] Logan City Council, “Welcome to Logan City Community Profile, 2017,” http://profile.id.com.au/logan. [10] K. S. Farbman, R. J. Vinci, W. R. Cranley, W. R. Creevy, and H. Bauchner, “The role of serial radiographs in the management of pediatric torus fractures,” JAMA Pediatrics,vol.153,no.9,pp. 923–925, 1999. [11] E. Koelink, S. Schuh, A. Howard, J. Stimec, L. Barra, and K. Boutis, “Primary care physician follow-up of distal radius buckle fractures,” Pediatrics, vol. 137, no. 1, Article ID e20152262, [12] C.E.Hill,J.P.M.Masters,andD. C.Perry,“A systematic review of alternative splinting versus complete plaster casts for the management of childhood buckle fractures of the wrist,” Journal of Pediatric Orthopaedics B,vol.25,no.2,pp.183–190, 2016. [13] A. Wallace and T. Cain, “Radiation risk of medical imaging for adults and children,” https://www.insideradiology.com.au/ radiation-risk-hp/. MEDIATORS of INFLAMMATION The Scientific Gastroenterology Journal of World Journal Research and Practice Diabetes Research Disease Markers Hindawi Hindawi Publishing Corporation Hindawi Hindawi Hindawi Hindawi www.hindawi.com Volume 2018 http://www www.hindawi.com .hindawi.com V Volume 2018 olume 2013 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 International Journal of Journal of Immunology Research Endocrinology Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 Submit your manuscripts at www.hindawi.com BioMed PPAR Research Research International Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 Journal of Obesity Evidence-Based Journal of Journal of Stem Cells Complementary and Ophthalmology International Alternative Medicine Oncology Hindawi Hindawi Hindawi Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2013 Parkinson’s Disease Computational and Behavioural Mathematical Methods AIDS Oxidative Medicine and in Medicine Neurology Research and Treatment Cellular Longevity Hindawi Hindawi Hindawi Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Radiology Research and Practice Hindawi Publishing Corporation

Are Unnecessary Serial Radiographs Being Ordered in Children with Distal Radius Buckle Fractures?

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Hindawi Publishing Corporation
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Copyright © 2018 Shi-Neng James Ling and Aidan J. Cleary. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Abstract

Hindawi Radiology Research and Practice Volume 2018, Article ID 5143639, 4 pages https://doi.org/10.1155/2018/5143639 Research Article Are Unnecessary Serial Radiographs Being Ordered in Children with Distal Radius Buckle Fractures? 1,2 1,2 Shi-Neng James Ling and Aidan J. Cleary Department ofOrthopaedics,LoganHospital,Meadowbrook,QLD,Australia Department of Orthopaedics, Redlands Hospital, Cleveland, QLD, Australia Correspondence should be addressed to Shi-Neng James Ling; jamesling9@hotmail.com Received 24 September 2017; Revised 17 December 2017; Accepted 15 January 2018; Published 1 March 2018 Academic Editor: Ali Guermazi Copyright © 2018 Shi-Neng James Ling and Aidan J. Cleary. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. Torus or buckle distal radius fractures are common injuries in the pediatric population. By definition, they are stable and can be treated conservatively with a wrist splint or soft crepe bandage. Objective. eTh objectiveofthisstudy wastoevaluatethe utility of serial radiographs in the clinical outcome of children with stable distal radius buckle fractures. Materials and Methods. A one-month retrospective analysis was undertaken at two major hospitals in Queensland—Logan and Redlands Hospital. Statistical analysis was performed to identify any relationships between serial radiographs and certain demographic parameters including fracture characteristics, age, sex, and limb side. Results. Of the 136 patients, 50% had more than one radiograph series taken. A total of 576 single radiographs and 251 radiograph series were taken. All fractures healed without complications and did not require active intervention. er Th e was a statistically significant relationship ( 𝑝=0.0015) between fracture angulation and multiple radiographs series. A cost analysis revealed $55,890 per year could be saved by not performing serial radiographs. Conclusion. Serial radiographs did not appear to change the excellent clinical outcome for children with distal radius buckle fractures. There is a potential to reduce costs and prevent unnecessary ionizing radiation exposure to children. 1. Introduction 2. Materials and Method Pediatric patients with a distal radius buckle or torus fracture Ethics approval for the study was obtained from Metro South are a common presentation to hospitals [1]. A torus or buckle Ethics Committee, approval number HREC/16/QPAH/543. A fracture is den fi ed as a compression failure of the bone, retrospective, multicentre review of all stable buckle distal usually at the metaphyseal and diaphyseal junction of the radius fractures in patients aged 0–16 was undertaken. All distal radius. eTh y are undisplaced but may be angulated [2]. cases which presented to the Logan and Redlands Hospital, These injuries have little to no tendency to displace and thus Queensland, Australia, over a one-month period from the 1st do not require active intervention. Most standard guidelines of February 2016 to the 1st of March 2016 were identified. recommend treatment with immobilisation in a cast, splint, Both Logan and Redlands Hospital are two major public or soft crepe bandage through their primary care physician metropolitan hospitals accepting all pediatric traumas [9]. All [3–7]. Currently, there is no consensus on the timing and cases of distal radius fractures presenting to the emergency frequency of radiographs in the follow-up of these injuries department were identified through the hospital’s coding in Australian Hospitals. As a result, unnecessary radiographs system. Computed radiographs were used in both locations. may be ordered, exposing children to potentially damaging Both authors individually reviewed all radiographs to identify levels of ionizing radiation [8]. Reducing radiographs would patients who had a buckle fracture that was undisplaced and also reduce costs and resources for the health system. u Th s, either not angulated or angulated less than 10 degrees (see the aim of this study was to assess the utility and frequency Figure 1). of serial radiographs in the management of stable pediatric To ensure diagnostic accuracy, the radiologist report was buckle distal radius fractures. concurrently reviewed with no discrepancies found. Data was 2 Radiology Research and Practice Stable buckle fracture (<10 degrees of Stable buckle fracture, no angulation angulation) Figure 1: Angulated and nonangulated buckle fractures. Table 1: Patient demographics. or active intervention. No re-presentations or complications were identiefi dwithinatleasta6-month time frame. Total number of patients 136 An analysis was performed to identify factors which were Mean age (years) 9 associated with a patient receiving multiple radiograph series Age range 0–16 (Table 3). er Th e was a statistically significant association Sex (male/female) 83/53 between fracture angulation and a patient having multiple Side (left/right) 83/53 radiograph series (𝑝 = 0.0021). eTh re were no signicfi ant Nonangulated/angulated 95/41 associations with age, limb, side, and gender. An extra 115 radiograph series were ordered on top of the 136 series that were performed for initial diagnosis. eTh collected from the clinical records of all patients with regard Australian Medicare Benefits Schedule of 2014 reports a fee to their demographics, type of fracture, clinical outcome, and of $40.50 for wrist radiographs(15).This equatestoasaving number of radiographs and radiograph series. “Radiographic of $4657.50 over the audit period, which translates to a series” was defined as an individual episode of radiograph potential cost saving of approximately $55,890 between the images taken, accompanied by an official request form com- two hospitals per year. pleted by a medical practitioner. It usually consists of at least two views including anterior-posterior (AP) projection and 4. Discussion a lateral projection and occasionally an oblique view. eTh information was recorded on an electronic spreadsheet. Cases eTh re are currently no national guidelines for the use of were excluded if they did not meet the definition of a stable radiographs in managing pediatric buckle fractures. In our buckle fracutre or had images not loaded onto the hospital study, all patients healed without complication, regardless of imaging system or if the clinical record was incomplete. An whether follow-up radiographs were ordered. This excellent analysis was performed using Stata 12 (Statacorp, Texas) to healing rate has been confirmed in multiple studies with identify any relationships between different variables. eTh patients almost always returning to a full level of function chi-squared and Fisher’s exact test were used for correlation with no ongoing deficit [10–12]. Performing serial radio- between categorical variables and the𝑡-test was for corre- graphs for these injuries thus appear to be unnecessary and lation between continuous variables. A 𝑝 value of <0.05 did not change clinical management. was considered statistically significant with a 95% confidence We acknowledge that there may be some perceived interval applied. A cost analysis was also performed using benefits for ordering serial radiographs for buckle fractures. information from the Logan Hospital Radiology Department With medico-legal issues becoming more intertwined in and the Australian Government Medicare Benefits Schedule the clinical management of patients, confirming radiological (MBS). union may provide added protection for the clinician. This information would also be useful when communicating with 3. Results the child’s guardian or carer, which can be dicffi ult at the best of times. One hundred and thirty-six patients with a buckle or torus Our analysis identified that fracture angulation was asso- fracture were included in the study whose demographics are ciated with a higher likelihood of repeat radiographic series. shown in Table 1. The hypothesised causes of this effect are likely multifactorial. Radiograph demographics are shown in Table 2. Half of We believethatthereisaninnate attitude ofthetreating the patients received multiple radiograph series during their clinicians to continue to monitor fractures that are not treatment course. perfectly anatomical, despite the evidence clearly showing All of the 136 fractures were clinically healed as per the that the natural history of this type of fracture is the same medical record without the need for any fracture reduction as that of a nonangulated fracture. This may represent a lack Radiology Research and Practice 3 Table 2: Radiograph demographics. Mean number of Total wrist Mean number of Patients with single Patients with multiple Total number of radiograph radiographs radiographs/patient radiograph series radiograph series radiograph series series/patient 576 4.24 68 68 251 1.85 Table 3: Correlation of factors related to a patient receiving multiple 5. Conclusion radiograph series. In our cohort of patients, buckle fractures angulated less than 10 degrees went on to heal without active medical Factor Single series Multiple series 𝑝 value intervention. This indicates that follow-up radiographs may Side be unnecessary in the clinical management of these injuries. Left 39 44 𝑝=0.3793 In our practice, we only perform a follow-up radiograph if Right 29 24 the patient has clinical evidence of delayed union or a gross Sex anatomical deformity. Male 38 45 𝑝=0.2184 Female 30 23 Disclosure Age Six and under 23 14 This research has been presented in part at the Royal Aus- 𝑝=0.0829 Over 6 45 54 tralian and New Zealand College of Radiologists 68th Annual Displacement Scientific Meeting. No angulation 56 39 𝑝=0.0015 Angulated 12 29 Conflicts of Interest eTh authors declare they have no conflicts of interest regard- ing the publication of this paper. of adequate education for medical staff and an area that could be easily addressed. References It was interesting to note that there was a correlation, however not statistically significant, between the age of a [1] K. W. Nellans, E. Kowalski, and K. C. Chung, “eTh epidemiol- patient and the likelihood of serial radiograph series. Age ogy of distal radius fractures,” Hand Clinics,vol.28, no.2,pp. may play a role in the number of radiograph series per- 113–125, 2012. formed for multiple reasons. eTh re is an increased potential [2] J. S. Davidson, D. J. Brown, S. N. Barnes, and C. E. Bruce, of remodelling for fractures at younger ages. Also, parent “Simple treatment for torus fractures of the distal radius,” The Journal of Bone & Joint Surgery,vol.83, no.8,pp. 1173–1175. expectations may be different for younger patients as opposed [3] A.C.Plint,J.J.Perry,R.Correll,I.Gaboury,and L. Lawton, to older patients and this may influence the doctor’s decision “A randomized, controlled trial of removable splinting versus to perform serial radiographs. casting for wrist buckle fractures in children,” Pediatrics,vol.117, The ALARA or “as low as reasonably achievable” prin- no.3,pp. 691–697, 2006. ciple is designed to minimize radiation exposure. Particu- [4] K.S.Khan,A.Grueff rty,O.Gallagher,D.P.Moore,E.Fogarty, larly in the pediatric population, it is important to attempt andF.Dowling,“Arandomizedtrialof’softcast’fordistalradius to reduce exposure as they are more vulnerable to the buckle fractures in children,” Acta Orthopaedica Belgica,vol.73, effects of ionizing radiation [8]. A child is exposed to no.5,pp. 594–597, 2007. an estimated radiation dose of 0.05–0.005 mSv per sin- [5] A.C.Plint,J.J.Perry,andJ.L. Y.Tsang, “Pediatricwristbuckle gle limb radiograph [13]. Although this dose is almost fractures: Should we just splint and go?” Canadian Journal of negligible in increasing the risk of cancer, the principle Emergency Medicine, vol. 6, no. 6, pp. 397–401, 2004. of minimizing radiation exposure remains important. This [6] E.Koelink,S.Schuh,A.Howard, J. Stimec,L.Barra,and study has found practical and simple ways to achieve this. K. Boutis, “Primary care physician follow-up of distal radius buckle fractures,” Pediatrics,vol.137,no. 1,ArticleIDe20152262, Further, the potential cost savings of limiting serial radio- graphs is significant. In a budget conscious health system, [7] S. West, J. Andrews, A. Bebbington, O. Ennis, and P. Alderman, the$55,890peryearcould bespentinother areasof “Buckle fractures of the distal radius are safely treated in a need. soft bandage: A randomized prospective trial of bandage versus This retrospective study was limited by its small sample plaster cast,” Journal of Pediatric Orthopaedics,vol.25, no.3,pp. size. Other limitations included not knowing the full indi- 322–325, 2005. cations for why the clinician ordered the serial radiograph. [8] A. Magistrellli, “eTh radioprotection of the child in emergency Further qualitative research could focus on the reasons radiology,” in Imaging Non-traumatic Abdominal Emergencies behind this, in an attempt to change clinical practice in order in Pediatric Patients,V.Miele andM.Trinci,Eds.,pp. 377–395, to reduce unnecessary radiographs. Cham: Springer International Publishing, 2016. 4 Radiology Research and Practice [9] Logan City Council, “Welcome to Logan City Community Profile, 2017,” http://profile.id.com.au/logan. [10] K. S. Farbman, R. J. Vinci, W. R. Cranley, W. R. Creevy, and H. Bauchner, “The role of serial radiographs in the management of pediatric torus fractures,” JAMA Pediatrics,vol.153,no.9,pp. 923–925, 1999. [11] E. Koelink, S. Schuh, A. Howard, J. Stimec, L. Barra, and K. Boutis, “Primary care physician follow-up of distal radius buckle fractures,” Pediatrics, vol. 137, no. 1, Article ID e20152262, [12] C.E.Hill,J.P.M.Masters,andD. C.Perry,“A systematic review of alternative splinting versus complete plaster casts for the management of childhood buckle fractures of the wrist,” Journal of Pediatric Orthopaedics B,vol.25,no.2,pp.183–190, 2016. [13] A. Wallace and T. Cain, “Radiation risk of medical imaging for adults and children,” https://www.insideradiology.com.au/ radiation-risk-hp/. MEDIATORS of INFLAMMATION The Scientific Gastroenterology Journal of World Journal Research and Practice Diabetes Research Disease Markers Hindawi Hindawi Publishing Corporation Hindawi Hindawi Hindawi Hindawi www.hindawi.com Volume 2018 http://www www.hindawi.com .hindawi.com V Volume 2018 olume 2013 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 International Journal of Journal of Immunology Research Endocrinology Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 Submit your manuscripts at www.hindawi.com BioMed PPAR Research Research International Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 Journal of Obesity Evidence-Based Journal of Journal of Stem Cells Complementary and Ophthalmology International Alternative Medicine Oncology Hindawi Hindawi Hindawi Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2013 Parkinson’s Disease Computational and Behavioural Mathematical Methods AIDS Oxidative Medicine and in Medicine Neurology Research and Treatment Cellular Longevity Hindawi Hindawi Hindawi Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018

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Radiology Research and PracticeHindawi Publishing Corporation

Published: Mar 1, 2018

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