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Management of Toddler's Fractures: A Systematic Review
Kristine Jeganathan1, Praniya Elangainesan, April J Kam
1From the Division of Pediatric Emergency Medicine, Department of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada.
Insights
Immobilization does not significantly improve clinical outcomes for toddler's fractures (TF). This systematic review found no difference in healing time or complications between immobilized and non-immobilized TF patients. Further research is needed for standardized treatment guidelines.
Area of Science:
- Pediatric Orthopedics
- Trauma Care
- Evidence-Based Medicine
Background:
- Toddler's fracture (TF) is a common pediatric injury.
- Current treatment strategies for TF vary, with debates on the efficacy of immobilization.
- Standardized guidelines for TF management in acute care are lacking.
Purpose of the Study:
- To systematically review and compare the efficacy of external fixation strategies for toddler's fractures (TF) in acute care.
- To determine if immobilization optimizes clinical outcomes (duration of immobilization, time to weight-bearing, complications) compared to non-immobilization.
- To identify best practices for TF management.
Main Methods:
- Systematic review conducted following PRISMA guidelines.
- Searched OVID Medline, Embase, and CINAHL databases for studies from 1937-2019.
- Included primary research articles assessing health outcomes of TF treatment strategies in acute care settings.
Main Results:
- Six studies were included after screening 2385 articles.
- Included studies comprised 5 retrospective chart reviews and 1 cross-sectional survey.
- No significant difference was found in clinical outcomes, including time to weight-bear and immobilization duration, between immobilization and non-immobilization groups for toddler's fractures.
Conclusions:
- Current evidence suggests immobilization does not offer significant clinical benefits over non-immobilization for toddler's fractures.
- Further large-scale prospective studies are necessary.
- The findings highlight the need for standardized guidelines for TF treatment in acute care settings.
Objectives:
The aim of this study was to examine and compare the efficacy of external fixation strategies of toddler's fracture (TF) in acute care settings. Specifically, we aim to identify whether immobilization optimizes clinical outcomes for patients (based on immobilization duration, time to weight-bear/ambulate, and associated complications) compared with nonimmobilization, with a systematic review.
Study Design:
After PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines, 2 independent reviewers searched electronic databases OVID Medline, Embase, and CINAHL for studies evaluating the health outcomes of various treatment methods for TF (1937-2019). The studies were chosen based on specific inclusion criteria. The 2 reviewers were looking for primary research articles that assessed health outcomes (such as immobilization duration, time to weight-bear/ambulate, and associated complications) of various treatment strategies for TF Fractures in acute care settings.
Results:
A total of 2385 articles were initially screened, reviewed, and then narrowed down to 6 studies for an in-depth analysis. Among these 6 studies, 5 were retrospective chart reviews and 1 was a cross-sectional online survey. A total of 565 patients from the retrospective chart reviews and 153 physicians from the cross-sectional online survey were further analyzed. The current evidence shows that there was no significant difference in clinical outcomes (ie, time to weight-bear and immobilization duration) between immobilization and nonimmobilization.
Conclusions:
Further large-scale prospective studies examining the clinical outcomes of TF management techniques should be conducted to establish a consistent standardized guideline for TF treatment across acute care settings.
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