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Bracing for Impact: A Comparative Analysis of Treatment Patterns for Pediatric Torus Fractures of the Radius
Emil Varas-Rodríguez1, Emmanouil Grigoriou1, Paul M Huddleston1
1Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
Insights
Bracing pediatric distal radius torus fractures is superior to casting, leading to fewer complications, shorter immobilization, and lower costs. This study highlights a gap between evidence and practice, emphasizing the need for provider education on optimal treatment methods.
Area of Science:
- Orthopaedic Surgery
- Pediatric Traumatology
- Evidence-Based Medicine
Background:
- Distal radius torus fractures are common pediatric injuries.
- Traditional management involves rigid casts, but evidence supports non-rigid immobilization for better outcomes.
- This study investigates current treatment patterns and their effectiveness.
Purpose of the Study:
- To compare treatment patterns, outcomes, and costs of casting versus bracing for pediatric distal radius torus fractures.
- To identify factors influencing treatment modality choice.
- To evaluate the adherence to evidence-based guidelines in clinical practice.
Main Methods:
- Retrospective review of 386 pediatric patients with distal radius torus fractures (2020-2022).
- Analysis of data from academic and community hospitals, comparing casting and bracing outcomes.
- Inclusion of demographic variables, provider type, and treatment outcomes.
Main Results:
- Casting was used in 71.2% of cases, with higher complication rates (11.6% vs. 2.7%), longer immobilization (6.08 vs. 4.68 weeks), and increased costs ($5,774.55 vs. $4,415.86).
- Physician assistants and orthopaedic residents were more likely to use casting.
- Bracing demonstrated superior outcomes and cost-effectiveness.
Conclusions:
- A significant gap exists between evidence supporting bracing and current casting practices for pediatric distal radius torus fractures.
- Bracing is associated with improved patient outcomes and reduced healthcare costs.
- Targeted provider education and institutional protocols are crucial for promoting evidence-based bracing use.
Introduction:
Distal radius torus fractures are common pediatric injuries traditionally managed with rigid casts. However, level 1 evidence supports non-rigid immobilization due to improved recovery, fewer complications, enhanced patient comfort, and decreased costs. This study evaluated treatment patterns for these fractures across academic and community hospitals, comparing outcomes and costs between casting and bracing. We hypothesized that casting would remain prevalent, especially in community settings and among non-orthopaedic providers.
Materials And Methods:
A retrospective review of electronic health records from 2020 to 2022 identified 386 patients with nondisplaced distal radial torus fractures. Data from academic and community hospitals were analyzed. Treatment method (cast vs. brace), demographic variables, provider type, and treatment outcomes were recorded.
Results:
The mean age was 8.34 years (range 0-16), 209 (54.1%) were male, and 153 (42.5%) had a concomitant ulnar fracture. Casting was utilized in 275 (71.2%) patients, while 111 (28.8%) received bracing. Physician assistants (PAs) managed most cases (41.2%), followed by orthopaedic surgeons (28.8%), orthopaedic residents (10.6%), nurse practitioners (10.1%), and other physicians (9.3%). Most patients presented to community healthcare centers (78.8%), while 82 (21.2%) presented to an academic institution.Casting was most frequently performed by non-orthopaedic surgery providers, especially PAs (83.6% casting rate, P < .001). Patients treated with casting had significantly higher complication rates (11.6% vs. 2.7%, P = .006). Patients treated with casting had longer immobilization (6.08 weeks vs. 4.68 weeks, P < .001), required more X-rays (3.33 vs. 2.76, P < .001), and incurred higher healthcare costs ($5,774.55 vs. $4,415.86, P < .001). Logistic regression identified PAs and orthopaedic residents as independent predictors of casting, while the presence of a concomitant ulnar fracture reduced the likelihood of casting (OR = 0.454, P = .003).
Conclusion:
Our findings reveal a gap between clinical evidence and current practice in treating pediatric radius torus fractures. While casting remains the predominant modality, bracing was associated with fewer complications, shorter immobilization time, and lower costs. These findings confirm bracing as the superior treatment option and highlight the need for targeted provider education.
Key Concepts:
(1)Bracing pediatric distal radius torus fractures results in fewer complications, shorter immobilization times, and lower estimated costs compared to casting.(2)Physician assistants and orthopaedic surgery residents were more likely to choose casting.(3)Institutional protocols and provider education play a key role in transitioning clinical practice to support the use of bracing for these fractures.
Level Of Evidence:
III (retrospective comparative study).
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