A pilot study of children attending an Emergency Department with foot or ankle injuries, hopping at presentation.
Aims In children presenting with foot and ankle injuries, an inability to weight bear is an indication for x-ray even in the absence of other signs of bony injury. Hopping is a vigorous action, quite different to the minimal movement that children with bony injuries adopt. We propose that hopping alone, with no other clinical features of a fracture, will not be associated with bony injury on x-ray; in essence that hopping and non weight bearing are not the same entity.
Methods Over a 2-year period, data was collected from children attending the department with foot and ankle injuries who hopped at presentation. The details recorded included the mechanism of injury, clinical findings, x-ray results and whether the children walked or hopped on discharge. All patients whose data was included in the study had x-rays either reported by the radiology department or by an Emergency Medicine Consultant.
Results A total of 66 proformas were completed but 18 were not included in the analysis as they had significant data missing (no x-ray report, no confirmation that they hopped into the department). From the remaining 48 patients, the following results were obtained:
9 patients had fractures on x-ray and in all cases these correlated with clinical findings.
The remaining 39 patients (81.25%) had no bony injury on x-ray. 26 of these 39 did have other clinical signs that would have merited x-ray. The remaining 13 children (27% of the total) had no abnormal findings on examination. All of the children with no bony injury walked from the department on discharge.
A Fisher's one-tailed test showed these results to be significant (p<0.05)
Conclusion This pilot study shows promising results but a larger study is required. If the results are replicated in a larger study, hopping could be distinguished from non weight bearing and, in children with injuries presenting with hopping alone and no other features to suggest bony injury, x-ray be avoided.
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