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Lower Extremity Fractures

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 INFORMATION REPOSITORY

 

 
 
Key studies English (14) French All (14)

Key Study: Do toddler's fractures of the tibia require evaluation and management by an orthopaedic surgeon routinely?

Visit

Adamich, J S and Camp, M W

This publication provies an evidence-based pathway can help prevent this overtreatment, reduce unnecessary radiation exposure and decrease the financial burden on families and the healthcare system.

Key Study: Reducing Time to Pain Medication Administration for Pediatric Patients with Long Bone Fractures in the Emergency Department

Visit

Schuman, S S, Regen, R B, Stuart, L H, Harrell, C, Jones, T L, Stewart, B M, ...

The purpose of this quality improvement project was to develop a protocol with the goal to administer pain medication to children presenting with suspected long bone fractures 47 minutes of emergency department arrival.

Key Study: Pediatric Femoral Shaft Fractures: A Multicenter Review of the AAOS Clinical Practice Guidelines Before and After 2009

Visit

Roaten, J D, Kelly, D M, Yellin, J L, Flynn, J M, Cyr, M, Garg, S, Broom, A, ...

To determine if the AAOS clinical practice guidelines (CPG) for the treatment of pediatric femoral shaft fractures (2009) changed treatment, we analyzed pediatric femoral shaft fractures at 4 high-volume, geographically separated, level-1 pediatric trauma centers over a 10-year period (2004 to 2013).

Key Study: Desaturation in procedural sedation for children with long bone fractures: Does weight status matter?

Visit

Hirsch, D G, Tyo, J and Wrotniak, B H

The objective of our study was to determine if overweight and obesity were associated with increased desaturations during procedural sedation compared with patients of healthy weight.

Key Study: Radiograph-Negative Lateral Ankle Injuries in Children: Occult Growth Plate Fracture or Sprain?

Visit

Boutis, K, Plint, A, Stimec, J, et al

To determine the frequency of SH1DF using magnetic resonance imaging (MRI) and compare the functional recovery of children with fractures identified by MRI vs those with isolated ligament injuries.

Key Study: Cost Consequence Analysis of Implementing the Low Risk Ankle Rule in Emergency Departments

Visit

Boutis, K, von Keyserlingk, C, Willan, A, Narayanan, UG, Brison, R, Grootendo...

Objective: To examine the costs and consequences of implementing the Low Risk Ankle Rule.

Key Study: Altered lower extremity fracture characteristics in obese pediatric trauma patients

Visit

Gilbert, SR, MacLennan, PA, Backstrom, I, Creek, A & Sawyer, J

Objective: To determine whether there are differences in fracture patterns and femur fracture treatment choices in obese versus nonobese pediatric trauma patients.

Key Study: Expedited Delivery of Pain Medication for Long-Bone Fractures Using an Intranasal Fentanyl Clinical Pathway

Visit

Schacherer, N M, Erikson Ramirez, D, Frazier, S B and Perkins, A M

This study aims to determine whether a pathway designed to facilitate the use of intranasal (IN) fentanyl for long-bone fractures will expedite the delivery of pain medication, decrease the total length of emergency department (ED) stay, and provide faster analgesia compared with intravenous (IV) morphine.

Key Study: Effect of the low risk ankle rule on the frequency of radiography in children with ankle injuries

Visit

Boutis, K, Grootendorst, P, Willan, A, Plint, AC, Babyn, P, Brison, RJ, Sayal...

Objective: To evaluate the effectivness of the Low Risk Ankle Rule in reducing the frequency of radiography in children with ankle injuries.

Key Study: Functional outcome after air-stirrup ankle brace or fiberglass backslab for pediatric low-risk ankle fractures: a randomized observer-blinded controlled trial

Visit

Barnett, PL, Lee, MH, Oh, L, Cull, G & Babl, F

Objective: To determine if the below-knee fiberglass posterior splint was as effective as the Air-Stirrup ankle brace in returning children with a low risk ankle fracture to their normal level of activity.

Key Study: Prospective validation and head-to-head comparison of 3 ankle rules in a pediatric population

Visit

Gravel, J, Hedrei, P, Grimard, G & Gouin, S

Objective: To determine the criterion validity of three rules for predicting clinically important ankle fractures in children.

Key Study: A randomized, controlled trial of a removable brace versus casting in children with low-risk ankle fractures

Visit

Boutis, K, Willan, AR, Babyn, P, Narayanan, UG, Alman, B & Schuh, S

Objective: To determine whether children who have low-risk ankle fractures that are treated with a removable ankle brace have at least as effective a recovery of physical function as those that are treated with a cast.

Key Study: Validation of the Ottawa Knee Rule in children: a multicenter study

Visit

Bulloch, B, Neto, G, Plint, A, Lim, R, Lidman, P, Reed, M, Nijssen-Jordan, C,...

Objectives: To determine the sensitivity and specificity of the Ottawa Knee Rules when they were applied to children, and to determine post hoc whether use of the rules would reduce the number of knee radiographs ordered.

Key Study: Validation of the Ottawa Ankle Rules in children with ankle injuries

Visit

Plint, AC, Bulloch, B, Osmond, MH, Stiell, I, Dunlap, H, Reed, M, Tenenbein, ...

Objectives: To determine the sensitivity and specificity of the Ottawa Ankle Rules in children and to determine the potential change in x-ray utilization.

Key Study: Do toddler's fractures of the tibia require evaluation and management by an orthopaedic surgeon routinely?

Visit

Adamich, J S and Camp, M W

This publication provies an evidence-based pathway can help prevent this overtreatment, reduce unnecessary radiation exposure and decrease the financial burden on families and the healthcare system.

Key Study: Reducing Time to Pain Medication Administration for Pediatric Patients with Long Bone Fractures in the Emergency Department

Visit

Schuman, S S, Regen, R B, Stuart, L H, Harrell, C, Jones, T L, Stewart, B M, ...

The purpose of this quality improvement project was to develop a protocol with the goal to administer pain medication to children presenting with suspected long bone fractures 47 minutes of emergency department arrival.

Key Study: Pediatric Femoral Shaft Fractures: A Multicenter Review of the AAOS Clinical Practice Guidelines Before and After 2009

Visit

Roaten, J D, Kelly, D M, Yellin, J L, Flynn, J M, Cyr, M, Garg, S, Broom, A, ...

To determine if the AAOS clinical practice guidelines (CPG) for the treatment of pediatric femoral shaft fractures (2009) changed treatment, we analyzed pediatric femoral shaft fractures at 4 high-volume, geographically separated, level-1 pediatric trauma centers over a 10-year period (2004 to 2013).

Key Study: Desaturation in procedural sedation for children with long bone fractures: Does weight status matter?

Visit

Hirsch, D G, Tyo, J and Wrotniak, B H

The objective of our study was to determine if overweight and obesity were associated with increased desaturations during procedural sedation compared with patients of healthy weight.

Key Study: Radiograph-Negative Lateral Ankle Injuries in Children: Occult Growth Plate Fracture or Sprain?

Visit

Boutis, K, Plint, A, Stimec, J, et al

To determine the frequency of SH1DF using magnetic resonance imaging (MRI) and compare the functional recovery of children with fractures identified by MRI vs those with isolated ligament injuries.

Key Study: Cost Consequence Analysis of Implementing the Low Risk Ankle Rule in Emergency Departments

Visit

Boutis, K, von Keyserlingk, C, Willan, A, Narayanan, UG, Brison, R, Grootendo...

Objective: To examine the costs and consequences of implementing the Low Risk Ankle Rule.

Key Study: Altered lower extremity fracture characteristics in obese pediatric trauma patients

Visit

Gilbert, SR, MacLennan, PA, Backstrom, I, Creek, A & Sawyer, J

Objective: To determine whether there are differences in fracture patterns and femur fracture treatment choices in obese versus nonobese pediatric trauma patients.

Key Study: Expedited Delivery of Pain Medication for Long-Bone Fractures Using an Intranasal Fentanyl Clinical Pathway

Visit

Schacherer, N M, Erikson Ramirez, D, Frazier, S B and Perkins, A M

This study aims to determine whether a pathway designed to facilitate the use of intranasal (IN) fentanyl for long-bone fractures will expedite the delivery of pain medication, decrease the total length of emergency department (ED) stay, and provide faster analgesia compared with intravenous (IV) morphine.

Key Study: Effect of the low risk ankle rule on the frequency of radiography in children with ankle injuries

Visit

Boutis, K, Grootendorst, P, Willan, A, Plint, AC, Babyn, P, Brison, RJ, Sayal...

Objective: To evaluate the effectivness of the Low Risk Ankle Rule in reducing the frequency of radiography in children with ankle injuries.

Key Study: Functional outcome after air-stirrup ankle brace or fiberglass backslab for pediatric low-risk ankle fractures: a randomized observer-blinded controlled trial

Visit

Barnett, PL, Lee, MH, Oh, L, Cull, G & Babl, F

Objective: To determine if the below-knee fiberglass posterior splint was as effective as the Air-Stirrup ankle brace in returning children with a low risk ankle fracture to their normal level of activity.

Key Study: Prospective validation and head-to-head comparison of 3 ankle rules in a pediatric population

Visit

Gravel, J, Hedrei, P, Grimard, G & Gouin, S

Objective: To determine the criterion validity of three rules for predicting clinically important ankle fractures in children.

Key Study: A randomized, controlled trial of a removable brace versus casting in children with low-risk ankle fractures

Visit

Boutis, K, Willan, AR, Babyn, P, Narayanan, UG, Alman, B & Schuh, S

Objective: To determine whether children who have low-risk ankle fractures that are treated with a removable ankle brace have at least as effective a recovery of physical function as those that are treated with a cast.

Key Study: Validation of the Ottawa Knee Rule in children: a multicenter study

Visit

Bulloch, B, Neto, G, Plint, A, Lim, R, Lidman, P, Reed, M, Nijssen-Jordan, C,...

Objectives: To determine the sensitivity and specificity of the Ottawa Knee Rules when they were applied to children, and to determine post hoc whether use of the rules would reduce the number of knee radiographs ordered.

Key Study: Validation of the Ottawa Ankle Rules in children with ankle injuries

Visit

Plint, AC, Bulloch, B, Osmond, MH, Stiell, I, Dunlap, H, Reed, M, Tenenbein, ...

Objectives: To determine the sensitivity and specificity of the Ottawa Ankle Rules in children and to determine the potential change in x-ray utilization.