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Wrist buckle fractures: a survey of current practice patterns and attitudes toward immobilization

Published online by Cambridge University Press:  21 May 2015

Amy Plint ,
Tammy Clifford ,
Jeff Perry ,
Blake Bulloch ,
Martin Pusic ,
Amina Lalani ,
Samina Ali ,
Bich Hong Nguyen ,
Gary Joubert  and
Kelly Millar
Amy Plint*
Affiliation:
Department of Pediatrics, Children’s Hospital of Eastern Ontario, and University of Ottawa, Ottawa, Ont.
Tammy Clifford
Affiliation:
Epidemiology; Chalmers Research Group, Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ont.
Jeff Perry
Affiliation:
Division of Emergency Medicine, Ottawa Hospital, Ottawa, Ont.
Blake Bulloch
Affiliation:
Department of Emergency Medicine, Phoenix Children’s Hospital, Phoenix, Ariz. Note: At the time of the study Dr. Bulloch was an Assistant Professor, Department of Pediatrics, Winnipeg Children’s Hospital, Winnipeg, Man.
Martin Pusic
Affiliation:
Department of Pediatrics, Vancouver Children’s Hospital, Vancouver, BC
Amina Lalani
Affiliation:
Department of Pediatrics, Hospital for Sick Children, and University of Toronto, Toronto, Ont.
Samina Ali
Affiliation:
Department of Pediatrics, Stollery Children’s Hospital, and University of Alberta, Edmonton, Alta.
Bich Hong Nguyen
Affiliation:
Department of Pediatrics, Sainte-Justine Hospital, Montreal, Que.
Gary Joubert
Affiliation:
Department of Pediatrics, Children’s Hospital of Western Ontario, and University of Western Ontario, London, Ont.
Kelly Millar
Affiliation:
Department of Pediatrics, Alberta’s Children Hospital, and University of Calgary, Calgary, Alta.
*
Division of Emergency Medicine, Children’s Hospital of Eastern Ontario, 401 Smyth Rd., Ottawa ON K1H 8L1; 613 738-3237, fax 613 738-4852, plint@cheo.on.ca

Abstract

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Objectives:

Buckle fractures are the most common wrist fractures in children, yet there is little literature regarding their management. This study examined the management of these fractures and attitudes toward their immobilization by pediatric emergency department (ED) physicians and pediatric orthopedic surgeons.

Methods:

A standardized survey was mailed to all pediatric orthopedic surgeons and pediatric ED physicians at 8 Canadian children’s hospitals.

Results:

Eighty-seven percent of physicians responded, including 33 of 39 pediatric orthopedic surgeons and 84 of 96 pediatric ED physicians. Sixty-four percent of respondents believe that wrist buckle fractures always need to be immobilized; pain control was most frequently cited for this belief. Physicians who did not believe that all buckle fractures need to be immobilized indicated that these fractures are inherently stable and have a low risk of refracture. Forty-eight percent of the orthopedic surgeons prefer below-elbow casts, 30% prefer a combination (splint and cast) and 12% prefer backslabs. Sixty percent of ED physicians “usually or always” use casts and 31% “usually or always” use backslabs. Although there was variation among the orthopedic surgeons regarding the recommended length of immobilization, most (70%) recommended 2 to 4 weeks, although some (12%) treated only until pain free. ED physicians showed greater diversity regarding length of immobilization.

Conclusions:

Although many physicians believe that wrist buckle fractures need to be immobilized, a significant number do not. There is substantial variability in the type and length of immobilization used. This variability suggests that the optimal management strategy for wrist buckle fractures is unclear and should be determined in future prospective studies.

Keywords

childrenfracturewristtreatment
Type
Pediatric EM • Pédiatrie d’urgence
Information
Canadian Journal of Emergency Medicine , Volume 5 , Issue 2 , March 2003 , pp. 95 - 100
Copyright
Copyright © Canadian Association of Emergency Physicians 2003

References

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