Are Routine Post-Cast Removal Radiographs and a Second Follow-up Appointment Necessary in the Management of Nondisplaced or Minimally Displaced Distal Radius Fractures?

Abstract

Background: The effectiveness of routine follow-up radiographs and appointments after cast removal when managing minimally displaced pediatric distal radius fractures has not been conclusively proven. This study aims to assess how often follow-up appointments and radiographs taken after cast removal alter management of patients with minimally displaced distal radius fractures.

Methods: A single-center retrospective chart review was conducted on patients under 18 years of age with minimally displaced distal radius fractures between 2017 and 2023. Demographic information, fracture characteristics, time to follow-up, and each appointment outcome were recorded. A change in patient management following post-cast removal radiographs was defined as a need for closed reduction, operative intervention, or prolonged immobilization. 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-up visits were also noted.

Results: Ninety-three patients met the inclusion criteria; 1.1% (1 of 93) of patients had their management changed following their post-cast removal radiographs according to our criteria. One patient was indicated for prolonged immobilization for a visible fracture line; no patients were indicated for surgery or closed reduction. Thirty-eight patients who underwent cast removal attended their 2nd follow-up appointment; 2.6% (1 of 38) of patients had their management changed according to our criteria. One patient required an additional follow-up appointment for a physeal check; no patient required a physical therapy referral. Two patients had an unscheduled appointment after discharge of care, due to parental desire of recovery confirmation before returning to gym play. No changes in fracture alignment were observed during any follow-up radiographs.

Conclusions: This study suggests that post-cast removal radiographs and second follow-up appointments rarely alter management of minimally displaced distal radius fractures. Limiting unnecessary visits and imaging could reduce costs and ease the burden on patients and families.

Key concepts: 1) Post-cast removal radiographs rarely altered management for minimally displaced pediatric distal radius fractures.2) Only 1.1% of patients required prolonged immobilization, with no cases needing surgery or closed reduction.3) Second follow-up appointments infrequently changed management, with only 2.6% of patients requiring an additional visit.4) Unscheduled visits were primarily driven by parental concerns rather than clinical necessity.5) No changes in fracture alignment were observed in any follow-up radiographs.

Level of evidence: Level IV - case series.