Pediatric Forearm Fractures Are Effectively Immobilized With a Sugar-Tong Splint Following Closed Reduction

Dittmer, Alison; Molina, Domingo; Jacobs, Cale A.; Walker, Janet L.; Muchow, Ryan D.

doi:10.1097/bpo.0000000000001291

Cited by 14 publications

(19 citation statements)

References 9 publications

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“…A successful reduction and stabilization in the PED with optimal functional outcome at follow-up was reported in all our patients, but 17 of them (3.94%) had an alignment loss at 7 days, although such percentage is lower than what is reported in the literature 37,38 . Our findings are consistent with the known add-on value of simulation-based teaching, which accounts for a small cost investment in education that can result in a larger outcome 39,40 …”

Section: Discussionsupporting

confidence: 88%

Quality Improvement Initiative Using Blended In Situ Simulation Training on Procedural Sedation and Analgesia in a Pediatric Emergency Department

et al. 2021

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IntroductionThere is evidence in the literature for high-fidelity in situ simulation training programs being an effective modality for physicians training. This quality initiative focused on implementation of the procedural sedation and analgesia (PSA) in our pediatric emergency department (PED). The primary outcomes of this study were to evaluate the impact of blended in situ simulation training (BST) program on PSA for closed forearm fracture reduction in the PED and to assess its cost-effectiveness. The secondary outcomes were to estimate this change on PSA's clinical efficacy and safety.MethodsBetween 2014 and 2018, a single-center, quasi-experimental, uncontrolled before and after study on forearm fracture reduction management was conducted. To assess the impact of our BST-PSA course, both historical control and prospective analyses were performed. Statistical significance was based on Fisher exact test or Pearson χ2 test.ResultsEight hundred eighty-five children met inclusion criteria. A significant difference in the number of PSAs performed in the PED, before and after BST, was found (37% vs. 85.3%, P < 0.001). Furthermore, a reduction in the number of hospitalizations for closed fracture reduction was measured (68.2% vs. 31.8%, P < 0.001). The overall cost savings from the BST-enabled increase in PSAs carried out in the PED was €370,714 ($440,838) with a return on investment of 64:1. No significant increase of PSA-related adverse events was found, and no serious adverse events occurred.ConclusionsFindings provide evidence of the benefits of implementing BST to enable PSA use in the PED, with an improved patient flow and significant cost savings from avoiding unnecessary hospitalizations.

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Section: Discussionsupporting

confidence: 88%

Quality Improvement Initiative Using Blended In Situ Simulation Training on Procedural Sedation and Analgesia in a Pediatric Emergency Department

et al. 2021

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“…Assessment and analysis of any complications were observed. [9][10][11][12][13][14] We found a male majority in incidence according to sex in our analysis, with males accounting for 54.8% and females for 45.2% with M:F ratio being 1. [9,[11][12][13][14] .…”

Section: Methodsmentioning

confidence: 91%

“…[9][10][11][12][13][14] We found a male majority in incidence according to sex in our analysis, with males accounting for 54.8% and females for 45.2% with M:F ratio being 1. [9,[11][12][13][14] . The right hand was injured in 54% of cases, whereas the left hand was injured in 46%, similar incidence was seen in studies done by (63%,37%) study [9,[14][15][16] The most common manner of injury identified in our study was a fall (86%), followed by an assault (10%), and road traffic accident (4%).…”

Section: Methodsmentioning

confidence: 97%

Various treatment modalities in fractures of shaft of radius and ulna in children and associated complications at rural hospital

Shihora¹,

Somani²,

Herode³

2021

Int. J. Orthop. Sci.

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Fractures of both bones of the forearm are very common orthopaedics injuries in the paediatric age group. The majority of these fractures are usually treated by traction, reduction and above elbow casting. The present study is undertaken to study various treatment modalities and their postoperative complications and functional results. Methods: It is a prospective study which was carried out from October 2019 to September 2021 in Pravara Rural Hospital, Loni, Ahmednagar. In this study 73 cases of fracture radius ulna of paediatric age group were treated by closed reduction and above elbow cast application and closed/open reduction with TENS nail fixation. Results: A sample size of 73 patients were selected according to the inclusion and exclusion criteria coming to the hospital with fracture of shaft of radius and ulna. The patients in the study, ranged in age from 5 to 12 years old, with an average age of 8.315 years. The study discovered that males account for 54.8% of the incidence, while females account for 45.2% with male to female ratio being 1.2:1. The right hand was injured in 54% of cases, whereas the left hand was injured in 46%. A fall was the most common type of injury in our study (86%) followed by an assault (10%) and a traffic accident (4%). Conservative management had a higher union rate than other modalities. Postoperative swelling is more common in CRIF/ORIF with TENS nailing. Conclusion: Conservative management with cast application remains the first choice for both-bone forearm fracture in children. In TENS nailing, complications are higher when compared to conservative management but still remains a good treatment modality for adolescent forearm fractures.

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“…In the pediatric population, DRFs represent 25% of all fractures with a significant incidence in the age group 10-14 years [ 4 ]. The subsequent loss of reduction occurs in 5% to 75% of pediatric forearm fractures [ 5 ]. The closed reduction of pediatric forearm fractures is implemented with a known physiological range of supination and pronation motion.…”

Section: Introductionmentioning

confidence: 99%

A Retrospective Cohort Study Comparing the Outcomes of Conservative Versus Operative Fixation of Distal Radius Fractures in Children

Aladraj¹,

Keshta²,

Mukhtar³

et al. 2022

Cureus

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Distal radius fractures are common pediatric orthopedic injuries accounting for 25% of all fractures with a significant incidence in the age group 10-14 years. This study aims to evaluate the operative and nonoperative methods of treating distal radius fractures in children. MethodsThis is a retrospective cohort study conducted on 176 children with distal radius fracture. We studied the operative and non-operative treatments of all children presented with distal radius fracture to the emergency department of the Bahrain Defense Force (BDF) Hospital from January 1, 2015, to February 1, 2022. The inclusion criteria were as follows: age of 17 years or younger, distal radius fracture with or without complete displacement and skeletal immaturity managed as of non-operative or operative groups. Patients who did not have follow-up data after the date of surgery were excluded. The statistical analysis was performed using the software SPSS version 23.0 (IBM Corp., Armonk, NY). Continuous data expressed as mean, standard deviation and discrete variables were expressed as frequency and percentages. One-way Analysis of Variance (ANOVA) was used to compare the continuous variables between groups. The Student's t-test was used for the two-group comparison. For the comparison of discrete variables, a Chi-Square test or Fisher's exact test was used. ResultsSeventy-seven patients were conservatively managed with cast immobilization ("non-operative" group) in comparison to 99 patients who were surgically managed ("operative" group) with either percutaneous pinning (n=56) or flexinail (n=43). Fewer patients underwent physiotherapy in the operative group with 14 (25.0%) patients for percutaneous pinning and seven (16.3%) patients for flexinail versus 31 (40.3%) patients in the non-operative group (p<0.015). There were statistically significant differences in radial inclination (p<0.001) between conservative and percutaneous pinning (22.22±2.86 vs 18.76±3.33 degrees) and percutaneous pinning and flexinail (18.76±3.33 vs 22.37±3.44 degrees). Likewise, there was a significant difference found in ulnar variance between conservative and percutaneous pinning (-0.45±2.14 mm vs -1.47±1.93 mm, p=0.012) and conservative and flexinail (-0.45±2.14 mm vs -1.59±1.90 mm, p=0.009). There were a total of 25 documented complications. Nineteen (19.8%) complications occurred in the non-operative group versus five (7.2%) and one (2.3%) complications in percutaneous pinning and flexinail groups, respectively (p=0.003). The most common complication in the non-operative group was loss of reduction while in cast and subsequent need for surgical intervention. Ten of these patients underwent percutaneous pinning whereas nine were fixed by flexinail. ConclusionThis study illustrated an overall similar success between the surgical and the conservative treatments of distal radius fractures in children. Due to the higher complication rate reported in the conservative group, the conservative treatment cannot be considered safer than the surgical treatment.

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Pediatric Forearm Fractures Are Effectively Immobilized With a Sugar-Tong Splint Following Closed Reduction

Cited by 14 publications

References 9 publications

Quality Improvement Initiative Using Blended In Situ Simulation Training on Procedural Sedation and Analgesia in a Pediatric Emergency Department

Quality Improvement Initiative Using Blended In Situ Simulation Training on Procedural Sedation and Analgesia in a Pediatric Emergency Department

Various treatment modalities in fractures of shaft of radius and ulna in children and associated complications at rural hospital

A Retrospective Cohort Study Comparing the Outcomes of Conservative Versus Operative Fixation of Distal Radius Fractures in Children

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