An Update on Common Orthopedic Injuries and Fractures in Children: Is Cast Immobilization Always Necessary?

Hang, Brian; Gross, Claire; Otero, Hansel J.; Katz, Ryan D.

doi:10.1016/j.cpem.2017.02.001

Cited by 1 publication

(2 citation statements)

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“…Fracture types include: undisplaced spiral fracture, buckle fracture, and undisplaced Salter-Harris I and II fractures. These fractures usually occur from simple mechanisms such as running, stumbling, twisting and low height falls 2…”

Section: Introductionmentioning

confidence: 99%

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Retrospective chart review of minor tibial fractures in preschoolers: immobilisation and complications

2020

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ObjectiveTo compare the treatment practices (immobilisation vs non-immobilisation) of toddler fractures and other minor tibial fractures (both proven and suspected) in preschoolers, aged 9 months–4 years, and examine rates of ED re-presentations and complications.MethodsRetrospective chart review of presentations of minor tibial fractures, both proven (radiologically confirmed) or suspected (negative X-ray but clinical evidence of bony injury), in children aged 9 months–4 years presenting to a single tertiary level paediatric ED from May 2016 to April 2018. Data collected included treatment practices, subsequent unscheduled re-presentations (including reasons) and complications (defined as problems relating to the injury that required further active care).ResultsA search of medical records yielded 240 cases: 102 had proven fractures (spiral, buckle or Salter-Harris II) and 138 were diagnosed with a suspected fracture. 73.5% of proven fractures were immobilised, predominantly with backslabs. 79% of suspected fractures were treated with expectant observation without immobilisation. Patients treated with immobilisation were more likely to re-present to ED compared with non-immobilised patients (18/104, 17.3% vs 9/136, 6.6% RR 2.62, 95% CI 1.23 to 5.58). 21 complications were seen in 19/104 (18.3%) immobilised patients. There were eight skin complications (complication rate of 7.7%) and 11 cast issues (complication rate of 10.6%). Two (1.5%) of the 136 patients had complications related to pain or limp. Pain was uncommonly found, although follow-up was not universal.ConclusionIn our centre, proven minor tibial fractures were more likely to receive a backslab, whereas for suspected fractures, expectant observation without immobilisation was performed. Although there is potential bias in the identification of complications with immobilisation, the study suggests that non-immobilisation approach should be investigated.

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Section: Introductionmentioning

confidence: 99%

“…Paediatric bones remodel quickly, and minor, stable fractures heal well without surgical intervention or even cast immobilisation 2. Therefore, treatment should be aimed at controlling pain while minimising the risk of social disruption and iatrogenic harm, such as skin complications.…”

Section: Introductionmentioning

confidence: 99%