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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.

Sundeep Khosla, MD; L. Joseph Melton III, MD; Mark B. Dekutoski, MD
Mayo Clinic and Foundation
Rochester, Minn

1. Melton LJ III, Crowson CS, O'Fallon WM. Fracture incidence in Olmsted County, Minnesota: comparison of urban with rural rates and changes in urban rates over time. Osteoporos Int. 1999;9:29-37. FULL TEXT | WEB OF SCIENCE | PUBMED

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

JAMA. 2003;290:3193.

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Increasing Rates of Forearm Fractures in Children
Marc F. Swiontkowski
JAMA. 2003;290(24):3193.
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