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Abstract

Background: Constituting approximately 15.0% of fractures, pediatric elbow fractures often require surgical intervention. Accurate diagnosis in pediatric patients is challenging, demanding proficient radiographic expertise. Initial diagnosis falls to emergency medicine (EM) physicians and pediatricians, who may lack sufficient radiographic training. Previous research by Shrader found a 58.0% accuracy in non-academic EM physicians for pediatric elbow fractures. The purpose of the study is to build on Shrader’s work and assess orthopaedic surgery (OS), pediatric, EM, and residents’ ability to accurately interpret pediatric elbow radiographs.

Methods: OS, EM, and pediatric residents at a Level 1 trauma center in an academic institution examined 20 elbow radiographs (with or without Supracondylar fractures), each featuring three views without time restrictions. Responses on diagnosis, assessment of whether the injury required operative or nonoperative intervention, and the urgency for follow-up with a pediatric orthopaedic surgeon were documented.

Results: Fifty-four residents (24 pediatric, 14 EM, and 16 OS) had varying diagnostic accuracy: 53.0% for pediatric, 60.5% for EM, and 81.0% for OS). Supracondylar humerus fractures were frequently identified correctly, while medial epicondyle fractures were commonly missed. Treatment prioritization accuracy was low: 43.0% for pediatric, 47.0% for EM, and 63.0% for OS residents. OS residents demonstrated a positive correlation between years of training and diagnostic accuracy, while pediatric and EM residents initially improved, followed by regression in year three.

Conclusion: Non-orthopaedic trained residents at an educational institution struggle to correctly identify pediatric elbow fractures on radiographs. The authors recommend annual musculoskeletal education, prioritizing training in improving recognition of fractures, and when to make referrals to orthopaedics, in disciplines with first points of contact for pediatric patients.

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