One and Done: A Retrospective Analysis of Radiographic Overuse in Pediatric Clavicle Fractures.

Abstract

Clavicle fractures in children are typically managed nonsurgically due to immense bony remodeling potential. Therefore, repeat radiographs may not be necessary. This study aims to quantify repeat radiographs for pediatric nonsurgical clavicle fractures. A retrospective study was conducted of children aged 8 years or younger with clavicle fractures between 2018 and 2022 at a single institution. Children were excluded if the fracture was managed surgically, if initial radiographs were unavailable, or if there was a concomitant ipsilateral shoulder fracture. Medical reports of 244 children with a mean age of 3.5 years were reviewed. Most fractures were midclavicular (96.7%), of which 56.1% were nondisplaced and 40.6% were minimally displaced. 52.9% had only initial radiographs, 29.5% had up to two sets, 13.5% up to three, and 4.1% had four sets. The mean time from injury to follow-up was 4.2 days (initial), 23.2 days (second), 50.4 days (third), and 72.8 days (fourth). Routine healing was appreciated in all third and fourth sets of radiographs. Most initial radiographs were ordered by the emergency department (59.6%), with orthopaedic surgery ordering 89.4% of second-visit radiographs and nearly all radiographs afterward. Repeat clavicle radiographs needlessly expose children to radiation and their families to inessential costs and are unlikely to alter management. Eliminating third and fourth visit radiographs would have prevented 53 sets of radiographs in 43 children, mitigating over 487.6 µSv of radiation and saving approximately $24,910.