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Effectiveness of a Structured Training Program in Pediatric Distal Radial Fracture Reduction for Orthopaedic Advanced
Ambika Nair1, Beverly Teti1, Caroline Fay1
1The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Summary
Structured training enables advanced practice providers (APPs) to effectively manage distal radial fractures, achieving better outcomes than junior residents. This training improves fracture reduction and casting, reducing the need for surgery.
Area of Science:
- Orthopaedic Surgery
- Emergency Medicine
- Advanced Practice Provider Training
Background:
- Fracture care training for novice advanced practice providers (APPs) is not well-established.
- This study evaluates a structured training program's effectiveness for APPs in independent emergency department fracture management.
Purpose of the Study:
- To assess the efficacy of a structured training program for APPs in managing distal radial fractures.
- To compare APP-led fracture care outcomes with those of postgraduate year residents.
Main Methods:
- Retrospective review of 136 distal radial fracture reductions.
- Comparison between APPs with structured training, junior residents (PGY-2), and senior residents (PGY-4).
- Radiographic measurements and clinical outcomes (loss of reduction, need for surgery) were analyzed.
Main Results:
- APPs and experienced residents (TR4) achieved superior initial reductions compared to junior residents (TR2, SR2).
- APP group demonstrated better long-term outcomes in angulation and bone contact post-reduction.
- APP group showed significantly lower rates of reduction loss and subsequent surgical intervention.
Conclusions:
- Structured training equips APPs to achieve excellent distal radial fracture reductions and casting.
- APP-led fracture care, post-training, yields superior outcomes compared to junior orthopaedic residents.
- This training model enhances APP capability in independent fracture management within emergency settings.
