Improving Lower Extremity Casting Quality by Providing an Experienced Assistant in Pediatric Tibia Fractures Managed...

Area of Science:

• Orthopedics
• Pediatric Trauma
• Surgical Training

Background:

• The role of orthopedic technicians or advanced practice providers (OT/APP) in assisting trainees during on-call hours for pediatric fractures remains unevaluated.
• Tibial fractures are common pediatric long bone injuries, often managed non-operatively with closed reduction and casting.

Purpose of the Study:

• To assess if an experienced OT/APP assisting orthopedic surgery residents improves clinical outcomes for pediatric tibia fractures treated with closed reduction and casting.
• To compare cast quality and treatment success between residents working alone and those assisted by an OT/APP.

Main Methods:

• Retrospective chart review of pediatric tibial shaft fractures (2010-2017).
• Comparison of two cohorts: orthopedic residents (post-graduate year 2-4) performing closed reduction and casting alone versus those assisted by an OT/APP.
• Analysis of cast quality and treatment success using univariate statistics and Classification and Regression Tree (CART) analysis.

Main Results:

• The resident-alone group showed a higher rate of subsequent surgical intervention (31% vs. 14%) compared to the OT/APP assisted group.
• Evidence of "over" padding in the resident-alone group's casts.
• OT/APP assisted castings required more wedging at follow-up (17% vs. 0%), indicating less need for surgery.
• Initial fracture severity and lack of OT/APP assistance were predictors of surgical intervention.

Conclusions:

• Assistance from an OT/APP during initial tibia fracture casting may lead to better management of reduction loss through cast wedging, avoiding surgery.
• Absence of OT/APP assistance correlated with a higher rate of fractures requiring surgical intervention, partly due to casting technique.
• Implementation of a cast application-training program showed a trend toward reduced surgical intervention in the resident-only group, suggesting improved trainee casting skills are possible.