Evidence into Practice

Boutis, Kathy; Howard, Andrew; Constantine, Erika; Cuomo, Anna V.; Somji, Zeeshanefatema; Narayanan, Unni G.

doi:10.1097/bpo.0000000000000223

Cited by 33 publications

(14 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The results of a 2020 survey of Pediatric Orthopaedic Society of North America (POSNA) members (21.3% response rate) showed that 69% of respondents had come to favor treatment with a removable brace, although younger members (£20 years in practice) had a higher likelihood of adhering to the guidelines at 76% than older members at 51% 53 . This is a dramatic improvement from a similar survey in 2012 when only 29% of respondents used removable splinting for this injury 54 .…”

Section: Fracturementioning

confidence: 67%

What’s New in Hand and Wrist Surgery

Bohn

2023

Journal of Bone and Joint Surgery

View full text Add to dashboard Cite

Section: Fracturementioning

confidence: 67%

What’s New in Hand and Wrist Surgery

Bohn

2023

Journal of Bone and Joint Surgery

View full text Add to dashboard Cite

“…Some potential barriers to adoption of these new standards of practice include a lack of familiarity with recent literature supporting the ‘minimalist’ approach, prior provider experiences, patient and caregiver preferences, concerns regarding splint compliance, and inability or lack of confidence in accurately identifying fractures appropriate for minimalist treatment. Boutis and colleagues explored the barriers to emergency 14 and paediatric orthopaedic 13 provider utilization of splints in the management of paediatric fractures with low rates of complications. Emergency providers felt constrained by the availability of commercial splinting devices and the support of their orthopaedic colleagues, while both groups expressed concerns about patient compliance and potential complications with removable forms of immobilization.…”

Section: Discussionmentioning

confidence: 99%

“…Although recent studies have begun to evaluate provider opinions regarding minimalist strategies in the treatment of buckle fractures of the distal forearm and other paediatric orthopaedic injuries, 13 , 14 to our knowledge, no prior study has examined ‘real world’ provider uptake and implementation of these practices since the emergence of this literature. The purpose of this study was to evaluate the current management of paediatric torus fractures at a single institution by examining the type and duration of immobilization prescribed, the utilization of radiographs in follow-up, and the number and duration of clinical encounters.…”

Section: Introductionmentioning

confidence: 99%

Buckling down on torus fractures: Has evolving evidence affected practice?

Williams

Alvarado

Montoya-Williams

et al. 2018

Journal of Children's Orthopaedics

View full text Add to dashboard Cite

PurposeThe purpose of this study was to evaluate the management of paediatric torus fractures of the distal forearm in current practice in light of growing evidence supporting a ‘minimalist’ approach with splint immobilization and limited follow-up. We hypothesized that ‘traditional’ cast-based management has persisted despite alternative evidence.MethodsA retrospective review was performed of a consecutive series of paediatric patients diagnosed with torus fractures of the distal forearm between 2011 and 2014. Records were reviewed to abstract the type of immobilization (splint versus cast) prescribed at each visit, number of radiographic exams, duration of immobilization, number of clinical visits and complications. The primary outcome was the proportion of patients exclusively managed in splints. Injuries were grouped based on treatment into a cast group (CG) and a splint group (SG) for statistical analyses. Additionally, injuries were grouped by epoch of time to determine if immobilization usage patterns evolved.ResultsA total of 240 forty injuries met criteria for inclusion. Of these, 16 (6.7%) were exclusively splinted (SG). Relative to the CG, the SG had fewer clinical visits (p < 0.001), fewer radiographic exams (p < 0.001) and a shorter total encounter time (p = 0.015). No change in immobilization use occurred over the study period. In all, 21 (9.4%) of the CG experienced complications. No clinically significant displacements occurred in either group.ConclusionCast utilization and frequent radiographic follow-up remain prevalent at our institution in the management of paediatric torus fractures. Splint-only management was associated with fewer clinical visits, fewer radiographic exams and a shorter total encounter time.Level of Evidence Level IIITherapeutic retrospective cohort study

show abstract

“…Due to the excellent remodeling capacity and quick healing of skeletally immature bones, many upper extremity fractures can be treated without reduction or surgical intervention [5,6]. Multiple studies have shown splints to be a well tolerated method of managing common pediatric upper extremity fractures [7][8][9][10]. Splints provide a noncircumferential immobilization that allows for natural swelling and are faster and easier to apply than casts, although some children have difficulty adhering to use of the splint [3,4].…”

Section: Introductionmentioning

confidence: 99%

A quality improvement initiative to reduce cast transitions in a pediatric hospital

Rowan

Samora²

2020

Journal of Pediatric Orthopaedics B

View full text Add to dashboard Cite

A quality improvement protocol was implemented in a large tertiary care pediatric hospital to reduce the rate of transitions from emergency department (ED)-applied casts to another form of immobilization (waterproof cast, removable brace, or sling). The local standard of care prior to implementing this quality improvement project involved applying long-arm casts in the ED for children presenting with stable upper extremity injuries (those not requiring a reduction). We created a multidisciplinary quality improvement team with orthopedic and ED providers, as well as cast technicians, with the aim of reducing the transition rate of ED-applied casts in clinic by 50%. Multiple Plan-Do-Study-Act cycles were performed and data were evaluated monthly. Charge fees were determined to assess differences in costs between splints and casts. An independent samples t-test for equality of means was used to determine the ED length of stay of each group. Baseline data determined a cast transition rate of 59.9%. After implementing the quality improvement protocol, the cast transition rate was reduced to 25.0%, a 58% reduction. The length of stay in the ED for a patient receiving a splint as opposed to a cast was 26.2 ± 8.0 min shorter. The charge to a patient receiving a splint rather than an ED-applied cast was $291.25 less. In conclusion, implementation of a multidisciplinary quality improvement protocol resulted in a more than 50% reduction in the transition rate of ED-applied casts in the clinic. Furthermore, healthcare charges to families were reduced by nearly $130 000 annually after implementation of this protocol.

show abstract

Evidence into Practice

Abstract: Level II.

Cited by 33 publications

References 19 publications

What’s New in Hand and Wrist Surgery

What’s New in Hand and Wrist Surgery

Buckling down on torus fractures: Has evolving evidence affected practice?

A quality improvement initiative to reduce cast transitions in a pediatric hospital

Contact Info

Product

Resources

About