The socio-economical impact of paediatric fracture clinic appointments

Morris, Magdalena; Bell, Michael J.

doi:10.1016/j.injury.2005.12.010

Cited by 43 publications

(38 citation statements)

References 5 publications

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“…The socio-economic impact of our clinic seems to be lower than reported by Morris and Bell (2006), with less time off work (31% vs 40%) and loss of income (2% vs 18%). However, the proportion in employment was similar.…”

Section: Discussioncontrasting

confidence: 61%

“…Legally the child cannot be seen without a parent/carer (under 16 years). A single study has recently tried to quantify the socio-economical impact of fracture clinic attendance in the paediatric setting and the appropriateness of the visit (Morris and Bell, 2006); however, the aim of our study was to look at the attitudes of parents towards paediatric fracture clinic and possible reasons for nonattendance.…”

Section: Introductionmentioning

confidence: 99%

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Attitudes of parents towards an urban paediatric fracture clinic

Teoh

Chee

Simpson

et al. 2010

International Journal of Orthopaedic and Trauma Nursing

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Section: Discussioncontrasting

confidence: 61%

Section: Introductionmentioning

confidence: 99%

Attitudes of parents towards an urban paediatric fracture clinic

Teoh

Chee

Simpson

et al. 2010

International Journal of Orthopaedic and Trauma Nursing

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“…However, incidence rates vary among countries, ages, sexes and sites of injury (1)(2)(3). Due to the specific characteristics of children's bones, delayed and/or improper treatment of ankle fracture in children may cause bone deformity and disability (4,5). The process of bone formation involves a balance between osteoblast and osteoclast activity and the healing of fractures requires a large number of osteoblasts (6).…”

Section: Introductionmentioning

confidence: 99%

N‑methyl pyrrolidone promotes ankle fracture healing by inhibiting inflammation via suppression of the mitogen‑activated protein kinase signaling pathway

et al. 2018

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Abstract. N-methyl pyrrolidone (NMP), a small bioactive molecule, has the potential to stimulate bone formation and inhibit osteoclast differentiation. The aim of the present study was to investigate the effect of NMP on the inflammatory response and underlying molecular mechanisms in MG-63 cells. The mRNA and protein expression of cytokines from peripheral blood in children with or without ankle fracture were determined by reverse transcription-quantitative polymerase chain reaction (RT-qPCR) and ELISA, respectively. MG-63 cells were pre-treated with/without NMP and stimulated with 1 µM bradykinin (BK). The production of cytokines from MG-63 cells was assessed by western blotting and RT-qPCR. The expression of inducible nitric oxide synthase (iNOS) and cyclooxygenase-2 (COX-2) mRNA and protein were measured using western blotting and/or RT-qPCR. Western blotting was used to examine the activation level of mitogen activated protein kinase. Compared with healthy children, levels of tumor necrosis factor (TNF-α), interleukin (IL)-1β and IL-6 mRNA and protein were upregulated in children with ankle fracture. NMP treatment did not induce cytotoxicity in MG-63 cells. The BK-induced upregulation of TNF-α, IL-1β, IL-6, iNOS and COX-2 mRNA and protein was reversed in a dose-dependent manner by NMP. Furthermore, NMP downregulated the activation of c-Jun NH2-terminal kinase and p38 pathways, but not the extracellular signal-related kinase pathway. Therefore, the results of the current study demonstrate that NMP inhibits inflammation dependent on the mitogen-activated protein kinase pathway in MG-63 cells, indicating that it may be beneficial in the healing of fractures.

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“…For children in particular, there is considerable associated socio-economic cost for fracture clinic attendance [6]. In our region, 'Fracture pathway redesign’ has been made 'a key priority area’ by the Scottish Orthopaedics Services Development Group [7].…”

Section: Resultsmentioning

confidence: 99%

“…In 2006, Morris and Bell [6] used 71 paired patient and surgeon questionnaires from 100 consecutive appointments, to examine the appropriateness and socio-economical impact of paediatric fracture clinic appointments in Sheffield, UK. From the surgeon’s questionnaire data, it was suggested that (i) the clinic appointment was appropriate in 93%, (ii) the treatment plan was changed in 25%, (iii) the cast was changed or removed in 50%, (iv) a radiograph was made in 28%, and (v) a further referral was made in 10%.…”

Section: Discussionmentioning

confidence: 99%

Paediatric fracture clinic design – current practice and implications for change

Huntley

2014

BMC Res Notes

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BackgroundIn our region there has been considerable success in the redesign of adult fracture clinics. The aim of this study was to define our paediatric fracture clinic load, to assess the feasibility of increasing efficiency by decreasing inappropriate attendance.FindingsProspective case notes review of all attendees at 6 serial fracture clinics at the Royal Hospital for Sick Children (Glasgow) which has both local and tertiary referrals. Of 234 consecutive attendances across 6 fracture clinics, 34 (15%) were judged inappropriate: 13 had fractures not requiring orthopaedic follow-up (radial torus/clavicle/undisplaced metacarpal), and 21 had diagnoses or situations that were not appropriate. Of the 200 attendances deemed appropriate (172 fractures, 11 soft-tissue injuries, 9 infections and 8 acute atraumatic limps), there were 33 new referrals from the emergency department, and a further 39 were first-time attenders at the fracture clinic after an acute admission (37 were post-operative and 2 were non-operative). Of these 200, the treatment plan was changed for 67 (34%), a cast removed or exchanged for 92 (46%), and radiographs taken for 153 (77%). The overall discharge to return ratio was 76:158 (1:2.1), and for appropriate attenders 61:139 (1:2.3).ConclusionsTighter discipline can be applied to indications for fracture clinic appointments, including certain fracture types being discharged from the emergency department without unnecessary review - our particular fracture clinic numbers can be decreased by 15%. In the remaining attendances there are high radiograph and intervention rates, such that it seems unlikely that further reductions in attendance would be feasible.

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The socio-economical impact of paediatric fracture clinic appointments

Cited by 43 publications

References 5 publications

Attitudes of parents towards an urban paediatric fracture clinic

Attitudes of parents towards an urban paediatric fracture clinic

N‑methyl pyrrolidone promotes ankle fracture healing by inhibiting inflammation via suppression of the mitogen‑activated protein kinase signaling pathway

Paediatric fracture clinic design – current practice and implications for change

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