Comparison Radiographs of Extremities in Childhood: Recommended Usage

Extremity injuries, a common problem in pediatric practice, are responsible for a significant number of radiographic examinations performed on children each year. Radiologic diagnosis in these injuries may be complicated by the variable appearance of the growing skeleton, especially around the epiphyses and the physeal plate. In the past, it has been a common and accepted practice for pediatricians, generalists, orthopedic surgeons, and radiologists to obtain routinely radiographs of the uninjured limb1-3 for comparison with those of the injured extremity to rule out subtle fractures or dislocations. Recently, increasing concern about potential dangers of ionizing radiation, coupled with agitation from insurance carriers and governmental agencies to reduce escalating medical costs, has resulted in mounting pressure to limit diagnostic radiographic examinations. At the same time, however, rising malpractice litigation has, in many instances, forced physicians to obtain additional radiographic studies to "protect" themselves, especially in trauma cases. Radiographs of traumatized extremities contribute significant numbers of medicolegally oriented radiologic examinations each year. Although comparison views are no doubt helpful in some instances, until recently there has not been any effort to document the extent of use or diagnostic value of comparison views, especially those routinely obtained. Within the past two years there have been two studies on this problem. In 1977, a survey4 of pediatric radiologists throughout the United States and Canada sought to determine individual application of comparison views, whether selective or routine; factors that influence this use; extent of comparison views, whether single or multiple; and cost of the additional radiographic studies.