Purpose or Case Report: The growing skeleton has a radiographically different appearance from an adult’s until late adolescence when the physes fuse. If unfamiliar with recognizing these differences on a radiograph, it is common for normal variants to be misinterpreted as fractures and referred to subspecialty orthopedic care. The arising consequences are avoidable; however, to educate caregivers providing interpretations of pediatric orthopedic radiographs we must first understand why and how often these misinterpretations occur.
Methods & Materials: In this IRB approved cross-sectional study, one pediatric orthopedist’s visits at a pediatric subspecialty clinic over six months were reviewed through a search of electronic medical records using broad keywords. Cases fitting the criteria of being referred for a fracture subsequently interpreted as normal were included in the study. Relevant data from each case was recorded and grouped by similarities between misinterpretations.
Results: Of the 850 visits found using the keywords, 47 patients with a total of 51 misinterpreted fractures met the criteria to be included in this study. The youngest patient misinterpreted with a fracture was 18 months old, while the oldest patient was 17 years old. Overall, the average age at misinterpretation was 10.5 years. While there were 12 fracture types misinterpreted, Salter-Harris type I (23.5%) and avulsion fractures (27.5%) represent the majority.
Conclusions: An emphasis should be placed on the need for further education of radiographically recognizing normal pediatric variants to prevent lost time, resources, money, and unnecessary stress for families. Within only six months, one pediatric orthopedist was referred 46 patients for misinterpreted fractures from outside intuitions, representing 6% of all appointments containing at least one of the keywords in its visit description. These findings emphasize the need for and importance of pediatric subspecialists interpreting radiography. Added caution is necessary when interpreting Salter-Harris type I and avulsion fractures. These radiographic misinterpretations have been found to be most common in children between the ages of 10-12 years old, likely due to their small, yet open physes. Interpretations could potentially be improved by looking more closely for soft tissue swelling and better clinical histories by the referring physicians and radiographers. The results of this study will be used to educate caregivers providing interpretations of pediatric orthopedic radiographs.