Evaluating the Necessity of Follow-Up Radiographs in Nonoperative Clavicle Fractures in Children Aged 1 to 10 Years

BACKGROUND: Clavicle fractures are the most common long bone fracture in the pediatric population. It is common practice to obtain 2 follow-up x-rays around 1 and 3 months postinjury in nonoperative fractures. The goal of this study is to assess the rate of change in management following routine follow-up x-rays and to determine if follow-up x-rays can potentially be eliminated from standard clinical management for pediatric nonoperative clavicle fractures. METHODS: This is a retrospective chart review that included pediatric (age: 1 to 10 y) clavicle fractures from 4 attending physicians between January 1, 2010 and December 31, 2023 (n=615). Demographics, mechanism of injury, side of injury, time from injury to immobilization, type of fracture, type of immobilization, length of follow-up, and the number of follow-up x-rays were recorded. Patient outcome characteristics noted included pain at the final visit, physical therapy referrals, limited range of motion, changes in management, and complications. RESULTS: Five hundred four fractures from 496 patients (62.7% male) were included. The average age was 5.4 years (range: 1 to 10 y). A sling was used most often (63.9%) as immobilization. Average time from injury to discharge from care was 50.2 days (range: 15 to 204 d). During follow-up, 178 (35.3%) fractures had 1 x-ray, 226 (44.8%) fractures had 2, 74 (14.7%) fractures had 3, 19 (3.8%) fractures had 4, and 2 (0.4%) fractures had ≥5 follow-up x-rays. We observed 16 (3.2%) change in management cases and 8 (1.6%) complication cases. Of the 16 changes in management cases, 13 changes followed the first follow-up x-ray, while 3 followed the second. Of the 95 (18.8%) cases that had >2 follow-up x-rays, 2 (2.1%) experienced complications, 3 (3.2%) had a change in management, and 1 (1.1%) had both a complication and a change in management. CONCLUSIONS: Our results suggest that no more than 1 follow-up x-ray in nonoperative pediatric clavicle fractures is necessary unless otherwise indicated by clinical history and exam. Minimizing follow-up x-rays proves significant in eliminating costs and unnecessary radiation exposure. LEVEL OF EVIDENCE: Level IV-case series.