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

Area of Science:

• Orthopaedic Surgery
• Paediatric Trauma
• Healthcare Management

Background:

• Paediatric both-bone forearm fractures are common, frequently requiring operative intervention.
• The COVID-19 pandemic shifted focus towards non-operative management to minimize patient contact.
• Regional variations in managing these fractures necessitate evaluation.

Purpose of the Study:

• To evaluate regional paediatric forearm fracture management practices.
• To assess the potential for emergency department (A&E) treatment to decrease operating theatre utilization and general anaesthesia use.
• To conduct a cost analysis of different management strategies.

Main Methods:

• A multi-centre service evaluation across five regional units.
• Data collected from August 2019 to December 2020.
• Inclusion of 233 paediatric patients with forearm fractures.

Main Results:

• 32 out of 96 displaced fractures were successfully reduced in A&E, avoiding surgery.
• 172 fractures were managed operatively, while 61 were managed non-operatively.
• 58 patients had manipulation under anaesthesia (MUA) in theatre, incurring over £31,000 in theatre costs alone.

Conclusions:

• Significant variations in paediatric forearm fracture management practices exist regionally.
• Definitive A&E management or conscious sedation lists offer potential cost savings and improved patient experience.
• Standardized A&E protocols aligned with GIRFT principles could optimize outcomes and reduce healthcare costs.