Current Concept Review: Updates in Pediatric Upper Extremity Imaging

Minimizing radiation exposure is crucial for both patient and provider safety. The harmful effects of ionizing radiation are well-documented. Further research is necessary to effectively decrease these risks. The present study compiles the most recent data available from orthopedic surgery and radiology literature, with a focus on pediatric upper extremity imaging. The purpose of this study is to give a comprehensive update in order to improve patient and provider safety and guide future research.Radiographs are the most commonly employed imaging modality in the upper extremity, and there are a wealth of articles focusing on optimizing its use in pediatric patients. Recommendations include utilizing in-room fluoroscopy for final imaging after closed forearm fracture reduction in the emergency department and foregoing formal post-reduction radiographs. Additionally, literature supports that early postoperative radiographs and radiographs after pin removal in patients who have undergone closed reduction and percutaneous pinning of supracondylar humerus fractures do not change management. Similarly, pediatric patients who have been treated for musculoskeletal infection do not require follow-up radiographs, in the absence of clinical concern. Other imaging modalities, such as ultrasound, CT, and MRI have expanded their indications in pediatric upper extremity injuries in recent years. This includes ultrasound for diagnosing fractures and tendon pathologies, new CT technology which decrease radiation exposure, and MRI scans with potentially safer contrast agents.In summary, research has been expanding our understanding of radiation exposure and exploring ways to minimize this during pediatric upper extremity imaging. Further research is necessary to facilitate safer diagnostic tests in pediatric patients.