Alternative Splinting Vs Complete Plaster Casts for the Management Of Paediatric Wrist Buckle Fractures: A Service Evaluation Mr. Christopher Hill, MSc, BMBS, BMedSci (hons), MRCS University Hospital of Coventry and Warwickshire, UK Methods: Retrospective service evaluation at two hospitals of the West Midlands NHS Trust, UK was conducted Primary outcome: Immobilisation technique used in the management of paediatric wrist buckle fracture Secondary outcomes: The number of overall hospital attendances The number of orthopaedic clinic attendances Wrist buckle fractures (WBF) were defined using the standardised definition as per Vernooij et al. [1] Participants were identified using the hospital trust’s computerised radiology database (IMPAX) searching with specific eligibility criteria (see Table) Radiographs identified were hand-searched to identify true WBF To reduce inter-observer variability, a selection of 20 consecutive x-rays were independently reviewed by a Consultant Paediatric Orthopaedic Surgeon provided with the aforementioned definition and results compared with those of the author to ensure accuracy robustness Once participants had been identified, hand-searching through electronic clinic letters was performed to ascertain the type of immobilisation used and number of hospital attendances undertaken References: 1. Vernooij, C. M., Vreeburg, M. E., Segers, M. J. & Hammacher, E. R. (2012) Treatment of torus fractures in the forearm in children using bandage therapy. J Trauma Acute Care Surg, 72 (4): Bae, D. S. & Howard, A. W. (2012) Distal radius fractures: what is the evidence? J Pediatr Orthop, 32 Suppl 2 S Bohm, E. R., Bubbar, V., Yong Hing, K. & Dzus, A. (2006) Above and below-the-elbow plaster casts for distal forearm fractures in children. A randomized controlled trial. J Bone Joint Surg Am, 88 (1): Oakley, E. A., Ooi, K. S. & Barnett, P. L. (2008) A randomized controlled trial of 2 methods of immobilizing torus fractures of the distal forearm. Pediatr Emerg Care, 24 (2): Charnley, J. (1957) The Closed Treatment of Common Fractures. Edinburgh: Livingstone 6. Davidson, J. S., Brown, D. J., Barnes, S. N. & Bruce, C. E. (2001) Simple treatment for torus fractures of the distal radius. J Bone Joint Surg Br, 83 (8): Plint, A. C., Perry, J. J., Correll, R., Gaboury, I. & Lawton, L. (2006) A randomized, controlled trial of removable splinting versus casting for wrist buckle fractures in children. Pediatrics, 117 (3): Reed, M. H. (1977) Fractures and dislocations of the extremities in children. J Trauma, 17 (5): Masterson, E., Borton, D. & O'Brien, T. (1993) Victims of our climate. Injury, 24 (4): Kropman, R. H., Bemelman, M., Segers, M. J. & Hammacher, E. R. (2010) Treatment of impacted greenstick forearm fractures in children using bandage or cast therapy: a prospective randomized trial. J Trauma, 68 (2): Khan, K. S., Grufferty, A., Gallagher, O., Moore, D. P., Fogarty, E. & Dowling, F. (2007) A randomized trial of 'soft cast' for distal radius buckle fractures in children. Acta Orthop Belg, 73 (5): Karimi Mobarakeh, M., Nemati, A., Noktesanj, R., Fallahi, A. & Safari, S. (2013) Application of removable wrist splint in the management of distal forearm torus fractures. Trauma Mon, 17 (4): West, S., Andrews, J., Bebbington, A., Ennis, O. & Alderman, P. (2005) Buckle fractures of the distal radius are safely treated in a soft bandage: a randomized prospective trial of bandage versus plaster cast. J Pediatr Orthop, 25 (3): Williams, K. G., Smith, G., Luhmann, S. J., Mao, J., Gunn, J. D. & Luhmann, J. D. (2013) A randomized controlled trial of cast versus splint for distal radial buckle fracture: an evaluation of satisfaction, convenience, and preference. Pediatr Emerg Care, 29 (5): Objectives: To perform a retrospective service evaluation of current practice of paediatric wrist buckle fractures (WBF) management at a National Health Service (NHS) Trust located in the West Midlands of the United Kingdom To compare the results of the service evaluation with recent evidence to identify potential implications for future practice Results Summary: 177 consecutive WBF patients were identified 100% concordance between Consultant Paediatric Orthopaedic Surgeon and author regarding WBF identification Overall, two-thirds (66%) of these were managed using complete casting as opposed to alternative-splinting, thus requiring two hospital visits, the second for plaster cast removal 84% also received two orthopaedic clinic reviews instead of one Cost effectiveness analysis confirmed that alternative-splinting provides significant savings when compared to complete plaster casting, (£39.37 vs £4.63) Conclusions & Implications for Practice: The service evaluation demonstrates that two-thirds of paediatric WBF patients at the reviewed NHS Trust were managed with casting As per recent evidence [10-14], implementation of trust-wide use of alternative-splinting would provide significant advantages regarding patient and parent convenience, including: Reduced missed days off school and work A sooner return to normal activities But with no detrimental effect regarding pain or fracture complications All whilst promoting significant, demonstrable financial savings by use of a cheaper form of immobilisation (including materials and application cost) and a reduced number of clinic visits Implementation requires a trust decision on the method of alternative-splinting to be used and staff education regarding WBF diagnosis and patient counseling, all of which is currently underway at the aforementioned hospital trust, with production of a new patient information leaflet and clinical guideline and plans to re- evaluate in the future Introduction: Paediatric wrist Buckle (or Torus) fractures are a common, specific type of distal radius fracture, defined as “a fracture due to the impact of indirect violence or a fall on an outstretched hand which crumples the dorsal cortex (compression side), without disruption of the volar cortex (tension side) of the bone” [1] They are inherently stable with little inclination to displace [2-4] Traditionally managed using complete plaster casts [5] Necessitates f/u visits, increased time off school/work, inconvenience, and hospital treatment costs Recent evidence has confirmed treatment with alternative splints negates the need for extra hospital visits, saving hospitals & patients, time & money [6,7] with no significant increase in pain or fracture complications