Effectiveness of a Structured Training Program in Pediatric Distal Radial Fracture Reduction for Orthopaedic Advanced...

Training programs to prepare novice advanced practice providers (APPs) to reduce fractures have not been described or evaluated. The current study evaluated the effectiveness of a structured training program for APPs to deliver effective fracture care independently in emergency department settings.

We performed a retrospective review of the first 5 independent distal radial fracture reductions performed by each participant. Radiographic measurements and information regarding patient injury, loss of reduction, and the need for surgery due to failure of closed management were collected. Patients were treated by (1) APPs with structured training (APP group), (2) traditionally trained postgraduate year (PGY)-2 residents (TR2), (3) PGY-2 residents with additional simulation training (SR2), and (4) experienced PGY-4 residents (TR4).

We identified 136 patients: 28 treated by the APP group; 24, by TR2s; 52, by SR2s; and 32, by TR4s. Significant differences were seen in post-reduction angulation and percent contact, with the APPs and TR4s achieving better initial reductions as indicated by the least residual angulation and greatest percent contact (all p < 0.05). At the time of follow-up, reductions by the APP group had more favorable outcomes, compared with those performed by residents, with respect to angulation on lateral radiographs (p = 0.047) and percent contact on anteroposterior (p = 0.036) and lateral (p = 0.004) radiographs. Reductions performed by the APP group also showed lower rates of loss of reduction (p < 0.001) and subsequent surgery (p = 0.005).

APPs receiving structured training prior to independent care delivery achieved better reductions overall, placed better casts, and had lower rates of loss of reduction and subsequent surgery compared with junior orthopaedic residents.

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.