Accuracy and Determinants of Radiographic Diagnosis in Pediatric Hand Fractures

Purpose: To investigate the accuracy of radiographic diagnosis of pediatric hand fractures and factors that contribute to diagnostic errors. Methodology: We retrospectively reviewed cases of pediatric hand injuries in Srinagarind Hospital, Thailand, from January 2019 to December 2021. A total of 350 patients with accessible radiographs were interpreted by junior/senior radiology trainees, a pediatric/a senior radiologist, and two senior orthopedists. Age, sex, hand side, fracture type, and injury mechanism were collected. Results: Among 167 patients with fractures, 55 (32.9%) had multiple fractures. For missed fractures (103 instances), junior radiology trainees missed more frequently than pediatric radiologists, with 35 (34%) vs. 8 (7.8%) instances (P = 0.004). Overall accuracy in the interpretation of different fracture types was 100% for greenstick, 77.4% for torus buckle, 76% for simple fractures. The pediatric radiologist showed the highest accuracy in the diagnosis of Salter-Harris type compared to others, 49 (28.7%) vs. 25-33 (14.6%-19.3%) (P = 0.001). On univariable analysis, vehicle injury mechanism was a borderline negative factor associated with missed fractures (odds ratio (OR), 0.38; 95% confidence interval (CI), 0.14-1.01; P = 0.05). Conclusions: Our findings suggest that review by experienced pediatric radiologists is associated with higher diagnostic accuracy for pediatric hand fractures, particularly Salter-Harris injuries. Prospective studies are needed to determine whether incorporating senior review into routine workflows reduces missed diagnoses.