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December 24/31, 2003

Increasing Rates of Forearm Fractures in Children—ReplyIncreasing Rates of Forearm Fractures in Children—Reply

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;290(24):3193. doi:10.1001/jama.290.24.3193-a

In Reply: In response to Dr Swiontkowski, we do not have any data about the rates of negative radiographs in children with a history of forearm trauma over this time period, which would be the most direct way to address this possible explanation. We doubt, however, that our findings were influenced by changes in either access to care or thresholds for ordering radiographs. First, we have previously reported that we found no change in rates of distal forearm fractures in this sample between 1969-1971 and 1989-1991.1 Second, if there were an increased likelihood of diagnosis in the later time periods, one might have expected to also see an increase in incidence of fractures due to moderate trauma over the same time period. This was not the case, as the increase was largely limited to injuries related to more severe trauma.