1. From Theatre to Front Door: Changing the way we deliver fracture manipulation
Mr Nick Beattie
ST7 Trauma and Orthopaedic Surgery Royal Hospital Sick Children Edinburgh
Clinical Change

2. Co Authors Mr J Tsang ST6 Trauma and Orthopaedic Surgery
Miss Kate Bugler ST7 Trauma and Orthopaedic Surgery
Mr Simon Roberts ST6 Trauma and Orthopaedic Surgery
Mr Alastair Murray Consultant Paediatric Orthopaedic Surgeon
Miss Emily Baird Consultant Paediatric Orthopaedic Surgeon

3. Declarations
No financial conflict of interest declared
BOA 2016

4. Fractures in Children
30% of Children suffer a fracture before the age of 17 Cooper et al 2004
Forearm fractures account for 30% to 50% of all pediatric fractures
BOA 2016

5. Operative Journey Initial Radiograph Provisional Cast 19:33
20:00
Provisional Cast
10:54
Theatre Film
15.5 hours
Time to Definitive Management
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6. Problem
Time Consuming, Expensive, not needed
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7. The Aim of this Study
Is MUA in A+E a safe procedure and does performing the procedure in theatre have any actual benefits
Potential to initiate change in practice
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8. The A+E Protocol
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9. Operative Journey (ED Method)
17:10
Initial Radiograph
18:46
A&E Fix
1:5 hours
Time to Definitive Management
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10. Study Methods
All fractures deemed appropriate for MUA without instrumentation referred to Orthopaedics at RHSC
From August 1st 2015 for 6 consecutive months
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11. Results
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12. Results
Mean time to treatment in theatre group was 18 hours Vs 3 hours in the ED group
Re fracture in the ED group and 1 re fracture in the theatre group
All fractures united within acceptable limits
No re operations in either group
No complications from the procedural sedation or anaesthesia
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13. Saving: £1800 per patient Theatre cost: £2000 per patient
Cost Implications
Theatre cost: £2000 per patient
A+E cost: £112 per patient
Saving: £1800 per patient
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14. Saving: £64,192 Theatre cost: £112,000 A+E cost: £6272
Cost Implications
Theatre cost: £112,000
A+E cost: £6272
Saving: £64,192
BOA 2016

15. But……
Further reduction in costs still possible
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16. Conclusion
No adverse affects on union, malunion, reoperation or anaesthetic complications
Quicker and significantly lower in cost when compared with admission and treatment in theatre
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17. Recommendations
Treatment in Emergency Department for all fractures of the forearm and distal radius that can be managed by closed reduction and casting in children who are safe to undergo procedural sedation
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18. Questions
BOA 2016