Published online March 3, 2008
PEDIATRICS (doi:10.1542/peds.2007-1899)
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ARTICLE

Utility of Total Lower Extremity Radiography Investigation of Nonweight Bearing in the Young Child

Christopher M. Baron, MDa, Jayne Seekins, DOa, Marta Hernanz-Schulman, MDa, Chang Yu, PhDb and J. Herman Kan, MDa

a Department of Radiology and Radiological Sciences, Vanderbilt Children's Hospital
b Department of Biostatistics, Vanderbilt University, Nashville, Tennessee

OBJECTIVES. The purpose of this work was to determine the utility of total lower extremity radiographs versus dedicated tibia radiographs in the evaluation of the young child presenting with nonweight bearing without localizing signs.

METHODS. This was an institutional review board-approved retrospective review of 263 consecutive patients between the ages of 9 months and 4 years who were referred for total lower extremity radiography between September 29, 2001, and November 7, 2006. Among these, a total of 133 study subjects met inclusion criteria of presentation with nonweight bearing without localizing signs or history of previous trauma. The control population was selected from 1089 consecutive patients between the ages of 9 months and 4 years evaluated from January 5, 1999 and December 8, 2006, who had only tibia radiographs at presentation. From this group, a final control population of 128 patients was selected with similar presentation of nonweight bearing without localizing signs or history of previous trauma. Causes of nonweight bearing were recorded for both groups based on radiograph findings and additional studies performed during workup.

RESULTS. At initial presentation, fractures were present in 13 study patients (9.8%) and in 23 control patients (17.9%). Total fractures (when including follow-up) were present in 14 study patients (10.5%) and in 26 control patients (20.3%). Fractures were located in the tibia alone in 100% of patients in the study group. Extratibial fracture (metatarsal) was present in 1 patient in the control group (0.7%). Among the study group, additional diagnoses included rickets (n = 1), cerebellar ataxia (n = 1), and discitis with epidural abscess (n = 1).

CONCLUSIONS. Our study findings indicate that the diagnostic value of total lower extremity radiography is similar to dedicated tibia radiography in the workup of the nonweight-bearing young child without trauma history or localizing signs. Radiation and cost savings can be realized by reserving additional radiographs for patients with high clinical suspicion and normal findings on dedicated tibia radiography.

Key Words: fractures • radiation reduction in children • leg radiography • tibia fractures • gait

Abbreviations: ACR—American College of Radiology

Accepted Aug 31, 2007.