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Children break bones more easily than adults - so pediatric fractures are very common. There are several unique features of the pediatric musculoskeletal system that need to be considered in management decisions of all of these injuries - growth plates, plasticity, callus formation, remodeling potential, and partial breaks are some of the key ones. Recognition and appropriate management of pediatric fractures by ED providers is critical. While some common minor wrist and ankle fractures can be treated with a less conservative approach encouraging an early return to activities, other fractures if not treated properly can result in long term functional problems for the child and/or be a sign of child maltreatment.

BROWSE EVIDENCE REPOSITORY

 

Key studies

Key Study: Cost-effectiveness analysis of cast versus splint in children with acceptably angulated wrist fractures (2011)

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von Keyserlingk, C, Boutis, K, Willan, AR, Hopkins, RB, & Goeree, R

Objective: to assess the cost-effectiveness of wrist splints compared with routine casting in children with acceptably angulated distal radius greenstick or transverse fractures in a practice setting where casting is considered the standard of care.

Key Study: Pediatric distal radial fractures treated by emergency physicians (2009)

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Pershad, J, Williams, S, Wan, J, & Sawyer, JR

Objective: To assess short-term outcomes after distal forearm fracture reductions performed by emergency physicians.

Key Study: Femur fractures in the pediatric population: abuse or accidental trauma? (2010)

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Baldwin, K, Pandya, NK, Wolfgruber, H, Drummond, DS, & Hosalkar, HS

Objective: to determine whether accidental femur fractures in pediatric patients younger than age 4 could be distinguished from child abuse using a combination of presumed risk factors from the history, physical examination findings, radiographic findings, and age.

Key Study: Evidence into practice: pediatric orthopaedic surgeon use of removable splints for common pediatric fractures

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Boutis, K, Howard, A, Constantine, E, Cuomo, A, Somji, Z, & Narayanan, UG

Removable splints when compared with circumferential casts in randomized trials have been shown to be a safe and cost-effective method of managing many common minor distal radius and fibular fractures. This study estimated the extent to which this evidence is being implemented in clinical practice, and determined the perceived barriers to the adoption of this evidence.

Key Study: Epidemiology of pediatric fractures presenting to emergency departments in the United States

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Naranje, SM, Erali, RA, Warner, WC Jr, Sawyer, JR, & Kelly, DM

Objective: To identify the most frequent pediatric fractures per 1000 population at risk in the United States using the 2010 National Electronic Injury Surveillance System database and 2010 Census information.

Key Study: Management of toddler's fractures in the pediatric emergency department

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Schuh, AM, Whitlock, KB, & Klein, EJ

Objectives: To evaluate current practice in treatment of toddler's fractures, as well as subsequent healthcare utilization and complications.

Key Study: Paediatrician office follow-up of common minor fractures

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Koelink, E, & Boutis, K

Objectives: To determine paediatricians opinions, knowledge and perceived barriers to managing minor paediatric fractures in the office.

Key Study: Who are we missing? Too few skeletal surveys for children with humeral and femoral fractures

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Shelmerdine, SC, Das, R, Ingram, MD, & Negus, S

Objective: To determine the potential shortfall in skeletal survey referral for children presenting with an acute non-supracondylar humeral or femoral fracture.

Key Study: Evidence into practice: emergency physician management of common pediatric fractures

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Boutis, K, Howard, A, Constantine, E, Cuomo, A, & Narayanan, U

Objectives: To determine the proportion of emergency physicians who prescribe removable devices for distal radius buckle fractures and/or nondisplaced distal fibular Salter-Harris I fractures. The investigators also examined follow-up referral patterns for these injuries.

Key Study: Bone fractures in children: is there an association with obesity?

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Sabhaney, V, Boutis, K, Yang, G, Barra, L, Tripathi, R, Tran, TT, & Doan, Q

Objective: To determine the relationship between body mass index (BMI) and odds of extremity bone fractures in children.

Key Study: Extremity fracture pain after emergency department reduction and casting: predictors of pain after discharge

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Thompson, RW, Krauss, B, Kim, YJ, Monuteaux, MC, Zerriny, S, & Lee, LK

Objectives: To determine the prevalence of pediatric extremity fracture pain after emergency department (ED) discharge, compare pain severity between fractures requiring simple casting versus sedated reduction and casting, and explore predictors of postdischarge pain.

Key Study: Emergency ultrasound in the detection of pediatric long-bone fractures

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Barata, I, Spencer, R, Suppiah, A, Raio, C, Ward, MF, & Sama, A

Objective: The goal of this study was to assess the agreement between emergency physicians' and radiologists' final assessments of suspected long-bone fractures using emergency ultrasound and radiography, respectively, in the pediatric population.

Key Study: Diagnostic accuracy of bedside emergency ultrasound screening for fractures in pediatric trauma patients

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Sinha, TP, Bhoi, S, Kumar, S, Ramchandani, R, Goswami, A, Kurrey, L, & Galwan...

Objective: To assess the diagnostic accuracy of bedside ultrasound for fractures in pediatric trauma patients.

Key Study: Emergency room visits by pediatric fracture patients treated with cast immobilization

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Sawyer, JR, Ivie, CB, Huff, AL, Wheeler, C, Kelly, DM, Beaty, JH, & Canale, ST

Objectives: To determine when and why pediatric patients with cast complaints return to the emergency room (ER). If this could be determined, educational and treatment strategies may help decrease the number of these visits and the cost of care.

Key Study: Sonographic detection of radiographically occult fractures in pediatric ankle and wrist injuries

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Simanovsky, N, Lamdan, R, Hiller, N, Simanovsky, N,

Objective: To determine the effectiveness of high-resolution ultrasound (US) in differentiating radiographically occult fractures from sprains.

Key Study: A randomized prospective study of music therapy for reducing anxiety during cast room procedures

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Liu, RW, Mehta, P, Fortuna, S, Armstrong, DG, Cooperman, DR, Thompson, GH, & ...

Objective: To decrease anxiety through the use of music therapy.