Fracture of Children's Both-Bone Casting study (#CBBC)-A regional experience

Paediatric both-bone forearm fractures are common and often managed operatively. During the COVID-19 pandemic, non-operative management was preferred to minimise patient contact. This study evaluates regional management practices, the potential for definitive emergency department treatment to reduce theatre utilisation and general anaesthesia, and includes a cost analysis.

This study is a multi-centre simultaneous service evaluation project across five units in the region from 01/08/2019 to 31/12/2020. Institutions providing data registered this service evaluation locally. Data were collected from PACS and local electronic patient records.

In total, 233 paediatric patients (mean age 8 years) were included. Most fell onto the outstretched hand (27 trampoline, 20 monkey bars), 4 fell down stairs, and one was involved in an RTC. 222 fractures were closed, 11 open. 200 fractures were displaced, 33 undisplaced; 96 displaced fractures had a reduction attempt in A&E, of which 32 were successful avoiding surgery. Overall, 172 were managed operatively (94.2% displaced); 61 non-operatively (62.3% displaced). Surgical management included 76 MUA, 32 K-wire fixation, 29 ORIF and 35 TENS nailing. 58 patients underwent MUA in theatre with no attempt in A&E costing over £31,000 in theatre running costs alone.

This study highlights variations in practice and the potential for cost savings and improved patient experience through definitive A&E management or conscious sedation lists. Standardised emergency department protocols, in line with GIRFT principles, could optimise outcomes and reduce costs. A patient satisfaction study comparing MUA in theatre versus conscious sedation in A&E or a dedicated sedation list is warranted.