O3270: Are Post-cast Removal Radiographs and a Second Follow up Necessary in the Management of Nondisplaced Distal Radius Fractures?

Background: The effectiveness of regular follow-up radiographs for managing nondisplaced pediatric distal radius fractures has not been conclusively proven. This study aims to (1) assess how often radiographs taken after cast removal alter patient treatment and (2) examine the necessity of routine follow-up appointments in the management of patients with nondisplaced distal radius fractures following cast removal.

Methods: We conducted a single center retrospective chart review of patients under 18 years old that sustained non-displaced distal radius fractures between July 19, 2017 and June 20, 2022. Demographic information, fracture characteristics, time to follow-up and each appointment outcome were recorded. A change in patient management after postcast removal radiographs was defined as a need for closed reduction, a need for operative intervention, or a need for prolonged immobilization. In addition, the second follow up appointment was considered to modify management if it necessitated a Physical Therapy referral or an additional office visit. Unscheduled appointments and any changes in fracture alignment during follow visits were also noted.

Results: 128 patients met the inclusion criteria. The average age of patients at the time of injury was 10.3±3.3 years. A total of 103 patients received routine radiographs at their first follow up appointment after being casted/splinted. After these follow up radiographs, zero patients required operative fixation, or a closed reduction, one patient required prolonged immobilization due to their fracture line still being visible on the radiograph. 1% (1/103) of patients had their management changed following their post-cast radiographs according to our criteria. 34 patients who underwent cast removal attended their 2nd follow-up appointment, with zero of these patients requiring a Physical Therapy referral and one patient requiring an additional follow-up appointment, for a physeal check. 3% (1/34) of patients had their management changed following the second follow-up visit according to our criteria. Two patients had an unscheduled appointment after discharge of care, both were due to a parental need for recovery confirmation before returning to gym play. Zero patients had a change in fracture alignment noted during any follow up radiographs.

Conclusion: This study suggests that post-cast removal radiographs beyond the initial follow-up visit do not alter patient treatment or outcomes after nondisplaced distal radius fractures. Given the additional financial costs and the social burden of missed school and workdays for patients and families, limiting unnecessary follow-up and radiographs should be considered.