Trends in Management of Pediatric Distal Radius Buckle Fractures
Sarah E Lindsay1, Stephanie Holmes2, Ishaan Swarup3
1Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR.
Insights
Pediatric orthopedic specialists increasingly favor removable splints for distal radius buckle fractures (DRBFx). This shift reflects evolving treatment preferences for stable pediatric wrist injuries, prioritizing patient comfort and efficient care.
Area of Science:
- Orthopedics
- Pediatric Traumatology
- Evidence-Based Medicine
Background:
- Distal radius buckle fractures (DRBFx) are common pediatric wrist injuries.
- These stable fractures typically require brief immobilization for successful management.
- Understanding current specialist practices is crucial for optimizing care.
Purpose of the Study:
- To survey pediatric orthopedic specialists on their management preferences for DRBFx.
- To identify trends and variations in treatment approaches.
- To assess concerns influencing management decisions.
Main Methods:
- A 20-question survey was distributed to Pediatric Orthopaedic Society of North America (POSNA) members.
- The survey addressed immobilization, follow-up, imaging, and potential complications.
- Data were collected from 317 participants.
Main Results:
- 69% of respondents prefer removable wrist splints, a significant increase from 2012.
- Younger specialists (<20 years practice) showed a higher preference for removable splints (76%).
- 85% utilize shared decision-making; concerns about misdiagnosis/mismanagement persist.
Conclusions:
- The majority of pediatric orthopedic specialists now opt for removable splints for DRBFx.
- Treatment duration is typically three weeks or less, with minimal follow-up and no routine reimaging.
- Current practices represent a substantial change from 2012, indicating an evolution in DRBFx management.
Background:
Distal radius buckle fractures (DRBFx) represent nearly half of the pediatric wrist injuries. DRBFx are stable injury patterns that can typically be successfully managed with brief immobilization. The purpose of this study was to evaluate opinions and preferences of pediatric orthopaedic specialists regarding the management of DRBFx.
Methods:
The POSNA Trauma Quality, Safety, and Value Initiative (QSVI) Committee developed a 20-question survey regarding the treatment of DRBFx in children. The survey was sent twice to all active and candidate POSNA members in June 2020 (n=1487). Questions focused on various aspects of treatment, including type and length of immobilization, follow-up, and radiographs and on potential concerns regarding patient/family satisfaction and pain control, medicolegal concerns, misdiagnosis, and mismanagement.
Results:
A total of 317 participants completed the survey (response rate=21.3%). In all, 69% of all respondents prefer to use a removable wrist splint, with 76% of those in practice <20 years preferring removable wrist splints compared with 51% of those in practice >20 years (χ 2 =21.7; P <0.01). Overall, 85% of participants utilize shared decision-making in discussing management options with patients and their families. The majority of participants felt that the risk of complications associated with DRBFx was very low, but concern for misdiagnosis and mismanagement have required some respondents to perform closed or open reductions.
Conclusions:
In 2020, the majority of respondents treat DRBFx with removable splints (69%) for 3 or fewer weeks (55%), minimal follow-up (85%), and no reimaging (64%). This marks a dramatic shift from the 2012 POSNA survey when only 29% of respondents used removable splinting for DRBFx.
Level Of Evidence:
Level II.
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