Practical challenges of the concept of using Dual-energy X-ray absorptiometry in the management of pediatric distal radius fractures

Abstract

Distal radius fractures are the most common pediatric injuries with increasing numbers in the recent years. The diagnosis of distal radius fracture is usually based on history taking, physical examination, and plain wrist radiographies. However, the radiation risk of plain X-ray imaging is its major drawback when obtaining exposures in children in their growing age. During the last few years, Dual-energy X-ray absorptiometry (DXA) scanners became more available with a highly increased resolution. This has given the opportunity for its clinical use in trauma settings. DXA scan has been associated with lower radiation exposures compared with plain radiography. Here we have reviewed possible practical challenges of its use in the management of pediatric distal radius fractures. The radiation dosage could reduce dramatically if a modified DXA scan is used in emergency setting for the diagnosis. A portable DXA machine is needed in the orthopedic operating room for evaluation of the fracture reduction and inspection of pin trajectory. Software and hardware modifications are also needed for DXA machine when it is used for follow-up visits. These changes should enhance image resolution in the presence of pin and cast. The modified DXA machine would probably result in 20–80 times less radiation exposure during the management of a routine pediatric distal radius fracture.