title: Imaging of the elbow in children with wrist fracture: an unnecessary source of radiation and use of resources?
abstract: BACKGROUND
  Anecdotally accepted practice for evaluation of children with clinically suspected or radiographically proven wrist fracture in many urgent care and primary care settings is concurrent imaging of the forearm and elbow, despite the lack of evidence to support additional images. These additional radiographs may be an unnecessary source of radiation and use of health care resources.
  
  
  OBJECTIVE
  Our study assesses the necessity of additional radiographs of the forearm and elbow in children with wrist injury.
  
  
  METHODS
  We reviewed electronic medical records of children 17 and younger in whom wrist fracture was diagnosed in the emergency department. We identified the frequency with which additional radiographs of the proximal forearm and distal humerus demonstrated another site of acute injury.
  
  
  RESULTS
  We identified 214 children with wrist fracture. Of those, 129 received additional radiographs of the elbow. Physical examination findings proximal to the wrist were documented in only 16 (12%) of these 129 children. A second injury proximal to the wrist fracture was present in 4 (3%) of these 129 children, all of whom exhibited physical examination findings at the elbow. No fractures were documented in children with a negative physical examination of the elbow.
  
  
  CONCLUSIONS
  Although elbow fractures occasionally complicate distal forearm fractures in children, our findings indicate that a careful physical evaluation of the elbow is sufficient to guide further radiographic investigation. Routine radiographs of both the wrist and elbow in children with distal forearm fracture appear to be unnecessary when an appropriate physical examination is performed.
authors.affiliation: Department of Radiology, Wake Forest University Baptist Health, Medical Center Boulevard, Winston-Salem, NC, 27157, USA, laurengoldingmd@gmail.com.
authors.forename: Lauren P
authors.initials: LP
authors.lastname: Golding
authors.forename: Yousef
authors.initials: Y
authors.lastname: Yasin
authors.forename: Jasmeet
authors.initials: J
authors.lastname: Singh
authors.forename: Bettina M
authors.initials: BM
authors.lastname: Gyr
authors.forename: Alison
authors.initials: A
authors.lastname: Gardner
authors.forename: Evelyn
authors.initials: E
authors.lastname: Anthony
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004551:Elbow Joint / Q000000981:diagnostic imaging*; D005260:Female; D050723:Fractures, Bone / Q000000981:diagnostic imaging*; D006801:Humans; D007223:Infant; D008297:Male; D000069079:Radiation Exposure / Q000517:prevention & control*; D011859:Radiography; D014954:Wrist Injuries / Q000000981:diagnostic imaging*; D014955:Wrist Joint / Q000000981:diagnostic imaging*