Reducing Cost and Radiation Exposure During the Treatment of Pediatric Greenstick Fractures of the Forearm. Issue 8 (December 2016)

• Record Type: Journal Article
• Authors: Ting, Beverlie L.; Kalish, Leslie A.; Waters, Peter M.; Bae, Donald S.
• Is Part Of: Journal of pediatric orthopaedics. Volume 36:Issue 8(2016)
• Publication Date: 2016-12
• Subjects: forearm fractures -- greenstick fractures -- radiation -- reducing costs -- reducing radiation -- closed treatment greenstick fractures of the forearm; Pediatric orthopedics -- Periodicals; 618.927
• DOI: 10.1097/BPO.0000000000000560
• Languages: English
• ISSNs: 0271-6798

Abstract

Abstract : Background: We hypothesize that after successful closed reduction of pediatric greenstick fractures of the forearm, there is a low rate of lost reduction requiring intervention. By reducing the frequency of clinical and radiographic follow-up, we can reduce costs and radiation exposure. Methods: A retrospective analysis was performed on patients aged 2 to 16 years treated with closed reduction and cast immobilization for greenstick fractures of the forearm at our institution between 2003 and 2013. The primary endpoint was a healed fracture with acceptable alignment at the final radiographic evaluation. Time-derived activity-based costing was used for cost analysis. We estimated radiation exposure in consultation with our hospital's radiation safety office. Results: One hundred and nine patients with an average age of 6.9 years (range, 2 to 15 y) met the inclusion criteria. The initial maximal fracture angulation of the affected radius and/or ulna averaged 19.3 (SD=±8.7) degrees (range, 2 to 55 degrees). Patients were followed for an average of 60 days (range, 19 to 635 d). On average, patients received 3.6 follow-up clinical visits and 3.5 sets of radiographs following immediate emergency department care. Ninety-four percent of patients met criteria for acceptable radiographic alignment. Only 1 patient (0.9%; 95% confidence interval, 0.2%-5.0%) underwent rereduction, as determined by the treating physician. If clinical follow-up were limited to 2 visits and 3 sets of radiographs total, there would be a 14.3% reduction in total cost of fracture care and a 41% reduction in radiation exposure. Conclusions: This retrospective study suggests that pediatric greenstick fractures of the forearm rarely require intervention after initial closed reduction. We propose that 2 clinical follow-up visits and 3 sets of radiographs would reduce overall care costs and radiation exposure without compromising clinical results. Level of Evidence: Level IV—economic and decision analyses.