Fall is associated with back-to-school, Soccer and Football! Inevitably there is a corresponding increase in school-related illnesses, broken bones and concussions. Whether it is a playground or sports-related injury, your urgent care or practice needs to be prepared!
As you have probably experienced, clinical providers face unique challenges in the diagnosis of fractures in children; these include instances of minor trauma that may not raise suspicion for a possible fracture, poor localization of pain by young children, communication obstacles, and unexplained trauma history. In fact, published studies have cited the incidence of radiographically occult fractures in pediatric patients as high as 18% of all cases. The most common sites for these occult fractures are the elbow, knee, ischium, and distal fibula. It is important to keep in mind that even non-occult fractures can be very difficult to recognize by X-ray due to overlapping structures, under-mineralized ossification centers, non-perpendicular x-ray beam relative to the fracture line, poor image quality, and insufficient clinical information. We see instances of each case every day. We have found the best approach includes both X-Ray and clinical examination. We recommend our clinical providers consider empirical treatment with a splint or casting immobilization for a 1 to 3 week follow-up period even after a normal X-Ray report. This approach is highly successful when treating young patients, as time allows for the injury to either heal or become obviously apparent while already being treated.
Nearly 20% of the X-Ray exams we see are pediatric, which has resulted in our Urgent Care Radiologists becoming accustomed to the subtleties and nuances of this age group. Our fellowship-trained Pediatric Radiologists also serve on our QA committee so we can make sure young patients receive the appropriate treatment.