Healthcare Providers and Parents Highlight Challenges of Pediatric Hand Fracture Care

Lafrenière, Ann‐Sophie; Baykan, Altay; Hartley, Rebecca; Ronksley, Paul E.; Love, Shannan; Harrop, A. Robertson; Fraulin, Frankie Og; Campbell, Dave J.T.; Donald, Maoliosa

doi:10.1097/gox.0000000000004815

Cited by 2 publications

(3 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The study is significant as it sheds light on the management of supracondylar fractures in a resource-limited setting. The findings of this study will provide important information to healthcare professionals and policymakers not only in Sri Lanka but also in other developing countries facing similar challenges in providing care for pediatric fractures [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Descriptive Study on Epidemiology, Clinical Presentation, Treatment, and Outcome of Supracondylar Fractures Treated in a Base Hospital of Sri Lanka: A Single-Center Study

Mubarak,

Mohamed Anzar,

Kanagratnam

2023

Cureus

View full text Add to dashboard Cite

Introduction: Supracondylar fractures are common pediatric elbow injuries, with management in developing countries presenting challenges due to limited resources, inadequate facilities, and a lack of trained personnel. Method: This study aimed to describe the incidence, demographics, clinical presentation, treatment methods, and outcomes of supracondylar fractures treated at Ashraff Memorial Hospital (AMH)-Kalmunai, a base hospital in Sri Lanka. This is a retrospective descriptive study conducted between January 2019 and December 2020. Results: The study involved 79 children with supracondylar fractures. The majority of the children were male (70.9%) and their ages ranged from one to 15 years. The study identified falls as the most common presenting complaint (92.4%), followed by road traffic accidents (3.8%), native treatment (2.5%), and mismanagement (1.3%). The majority of fractures affected the right side (69.6%), while the remaining cases involved the left side (30.4%). Regarding the time duration from fracture to hospital presentation, a significant proportion of children sought medical attention on the same day (51.9%), followed by presentations within the first three days (38%), within a week (5.1%), or after a month (3.8%). Based on the Gartland classification, type I fractures accounted for 44.3% of cases, followed by type II fractures (29.1%) and type III fractures (26.6%). The most common treatment approach was closed reduction and percutaneous pinning (41.8%). Other treatment options included plaster of Paris (POP) cast without manipulation (36.7%), POP cast with manipulation (7.6%), analgesics alone (6.3%), and open reduction fixation (5.1%). Follow-up procedures varied, with routine cast removal (11.4%), routine cast and K-wire removal (45.6%), and re-do surgery with routine follow-up (1.3%). Among the type III fractures, two children presented with vascular compromise and anterior interosseous nerve (AIN) impairment, while another two children had AIN impairment only. Type I and type II fractures did not exhibit nerve involvement or vascular impairment. Only one out of the 79 children had an open fracture. Conclusion: Supracondylar fracture is the most common orthopedic fracture in children. The study sheds light on the challenges and opportunities associated with treating pediatric supracondylar fractures in a resource-constrained context. The findings can help produce guidelines for the management of supracondylar fractures in underdeveloped nations, as well as contribute to global efforts to enhance the management of pediatric fractures.

show abstract

Section: Discussionmentioning

confidence: 99%

Descriptive Study on Epidemiology, Clinical Presentation, Treatment, and Outcome of Supracondylar Fractures Treated in a Base Hospital of Sri Lanka: A Single-Center Study

Mubarak,

Mohamed Anzar,

Kanagratnam

2023

Cureus

View full text Add to dashboard Cite

show abstract

“…This qualitative descriptive study involved secondary analysis of data from four 90-minute virtual focus groups previously held with healthcare providers involved in the management of children treated for hand fractures and the children’s parents in Alberta, Canada (February 2020). 9 We used purposive sampling to include a broad representation of stakeholders: parents, physicians within emergency departments and urgent care centers, plastic surgeons, and hand therapists from both hospital and community settings. All participants were English-speaking and provided informed consent.…”

Section: Methodsmentioning

confidence: 99%

“…This work highlighted four themes around current management: a need for improved parent education throughout the hand fracture journey, lack of a streamlined referral process for simple hand fractures, need to identify the most appropriate care provider for simple hand fractures, and importance of maintaining strong multidisciplinary connections to facilitate care. 9 Building on the findings in that study, we aimed to further identify barriers to a new care pathway for pediatric hand fractures based on the CKHR and to generate tailored strategies to support its implementation.…”

Section: Introductionmentioning

confidence: 99%

Strategies Addressing Barriers to the Implementation of a Pediatric Hand Fracture Care Pathway

Baykan

Lafrenière

Fraulin

et al. 2023

Plastic and Reconstructive Surgery - Global Open

Self Cite

View full text Add to dashboard Cite

Background:We recently highlighted shortcomings in the care of pediatric hand fractures in our local context. The Calgary Kids' Hand Rule (CKHR) was developed to predict hand fractures that require referral to a hand surgeon. The aims of this study were to identify barriers to a new care pathway for pediatric hand fractures, based on the CKHR and to generate tailored strategies to support its implementation. Methods: We performed a conventional content analysis of transcripts from four focus groups (parents, emergency/urgent care physicians, plastic surgeons, and hand therapists) to identify relevant concepts (facilitators and barriers). These concepts were mapped to two frameworks. Generic strategies to address the barriers were identified, and further discussions with key stakeholders resulted in tailored strategies for implementation. Results: Five facilitators to implementation of a CKHR-based hand fracture care pathway included established rapport between hand therapists and surgeons, potential for more streamlined care, agreement on identifying another care provider, positive perceptions of hand therapist expertise, and opportunity for patient education. Two individual barriers were concern for poor outcomes and trust. Three systemic barriers were awareness and usability, referral process, and cost and resources. Strategies to address these barriers include pilot-testing of the new care pathway, ensuring closed loop communication, multiple knowledge translation activities, integration of CKHR into the clinical information system, coordinating care and development of parent handouts. Conclusion:Mapping barriers to established implementation frameworks has informed tailored implementation strategies, bringing us one step closer to successfully implementing a new pediatric hand fracture pathway.

show abstract

Healthcare Providers and Parents Highlight Challenges of Pediatric Hand Fracture Care

Abstract: Related Digital Media are available in the full-text version of the article on www.PRSGlobalOpen.com.

Cited by 2 publications

References 24 publications

Descriptive Study on Epidemiology, Clinical Presentation, Treatment, and Outcome of Supracondylar Fractures Treated in a Base Hospital of Sri Lanka: A Single-Center Study

Descriptive Study on Epidemiology, Clinical Presentation, Treatment, and Outcome of Supracondylar Fractures Treated in a Base Hospital of Sri Lanka: A Single-Center Study

Strategies Addressing Barriers to the Implementation of a Pediatric Hand Fracture Care Pathway

Contact Info

Product

Resources

About