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Key Resources

Evidence Repository: Fractures (upper and lower)

Evidence Repository: Fractures (upper and lower)

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Dr. Kathy Boutis

Dr. Kathy Boutis

Evidence repositories are collections of best available resources and evidence (clinical guidelines, peer reviewed literature, systematic reviews, etc.), collated by our knowledge synthesis team and content advisors. This evidence repository is not intended to be an exhaustive list of resources for a topic, but rather a curated list of current, evidence-based resources, based on expert consensus of relevance and usability for a general emergency department setting. We search databases (Cochrane Library, PubMed, TRIP Database) and web search engines (Google, Google Scholar) to locate evidence. Additionally, hospital websites are browsed for guidance documents, such as clinical practice guidelines (CPG) for healthcare professionals. 

Every effort is made to identify resources that are open access (i.e. publicly available, free of charge, not requiring a subscription). 

More information about the creation of our evidence repositories can be found at https://pubmed.ncbi.nlm.nih.gov/28537762/

Evidence repositories are collections of best available resources and evidence (clinical guidelines, peer reviewed literature, systematic reviews, etc.), collated by our knowledge synthesis team and content advisors. This evidence repository is not intended to be an exhaustive list of resources for a topic, but rather a curated list of current, evidence-based resources, based on expert consensus of relevance and usability for a general emergency department setting. We search databases (Cochrane Library, PubMed, TRIP Database) and web search engines (Google, Google Scholar) to locate evidence. Additionally, hospital websites are browsed for guidance documents, such as clinical practice guidelines (CPG) for healthcare professionals. 

Every effort is made to identify resources that are open access (i.e. publicly available, free of charge, not requiring a subscription). 

More information about the creation of our evidence repositories can be found at https://pubmed.ncbi.nlm.nih.gov/28537762/

Bottom Line Recommendations: Fractures  (2021)

Bottom Line Recommendations: Fractures

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Boutis K & TREKK Network

Boutis K & TREKK Network

The purpose of this document is to provide healthcare professionals with key facts and recommendations for the diagnosis and treatment of fractures in children. Original (version 1.0) published online: November 2015. Updated (version 2.0) published online: February 2018. Updated (version 3.0) published online: May 2021.

The purpose of this document is to provide healthcare professionals with key facts and recommendations for the diagnosis and treatment of fractures in children. Original (version 1.0) published online: November 2015. Updated (version 2.0) published online: February 2018. Updated (version 3.0) published online: May 2021.

Recommandations de Base: Fractures chez l'enfant  (2021)

Recommandations de Base: Fractures chez l'enfant

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Boutis, K & TREKK Network

Boutis, K & TREKK Network

Recommandations de base pour le diagnostic et le traitement des fractures chez les enfants. Original (version 1.0) publié en ligne en décembre 2016. Mise à jour (version 2.0) publiée en ligne février 2018Mise à jour (version 3.0) publiée en ligne mai 2021.

 

Recommandations de base pour le diagnostic et le traitement des fractures chez les enfants. Original (version 1.0) publié en ligne en décembre 2016. Mise à jour (version 2.0) publiée en ligne février 2018Mise à jour (version 3.0) publiée en ligne mai 2021.

 

Clinical guidelines

Clinical Practice Guideline: Apophyseal Avulsion Fractures of the Pelvis and Lower Extremity  (2010)

Clinical Practice Guideline: Apophyseal Avulsion Fractures of the Pelvis and Lower Extremity

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Mckinney, B & Roth, C

Mckinney, B & Roth, C

This is an AAOS clinical guideline on the pathophysiology and etiology, classification, diagnosis, and management of apophyseal avulsion fractures of the Pelvis and lower extremity.

This is an AAOS clinical guideline on the pathophysiology and etiology, classification, diagnosis, and management of apophyseal avulsion fractures of the Pelvis and lower extremity.

POSNA Study Guide: Upper Extremity Topics  (2019)

POSNA Study Guide: Upper Extremity Topics

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Pediatric Orthopaedic Society of North America

Pediatric Orthopaedic Society of North America

The POSNA Study Guide provides an overview of practice points related to fractures and other pediatric orthopaedic injuries of the upper extremity.

The POSNA Study Guide provides an overview of practice points related to fractures and other pediatric orthopaedic injuries of the upper extremity.

Clinical Practice Guideline: AAOS clinical practice guideline: the treatment of pediatric diaphyseal femur fractures  (2009)

Clinical Practice Guideline: AAOS clinical practice guideline: the treatment of pediatric diaphyseal femur fractures

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Kocher, MS, Sink, EL, Blasier, RD, Luhmann, SJ, Mehlman, CT, Scher, DM, Matheney, T & Sanders, JO

Kocher, MS, Sink, EL, Blasier, RD, Luhmann, SJ, Mehlman, CT, Scher, DM, Mathe...

This is a summary of the recommendations in the AAOS clinical practice guideline, The Treatment of Pediatric Diaphyseal Femur Fractures.

This is a summary of the recommendations in the AAOS clinical practice guideline, The Treatment of Pediatric Diaphyseal Femur Fractures.

Clinical Practice Guideline: Tibial Shaft Fractures  (2008)

Clinical Practice Guideline: Tibial Shaft Fractures

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Hoernschemeyer, DG, Khazzam, M & Hoffinger, SA

Hoernschemeyer, DG, Khazzam, M & Hoffinger, SA

This is an AAOS clinical guideline on the pathophysiology and etiology, classification, diagnosis, and management of tibial shaft fractures.

This is an AAOS clinical guideline on the pathophysiology and etiology, classification, diagnosis, and management of tibial shaft fractures.

Clincial Practice Guideline: Ankle Fractures in Adolescents  (2003)

Clincial Practice Guideline: Ankle Fractures in Adolescents

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Rieger, KJ, Hyman, J & Vitale, M

Rieger, KJ, Hyman, J & Vitale, M

This is an AAOS clinical guideline on the pathophysiology and etiology, classification, diagnosis, and management of ankle fractures in adolescents.

This is an AAOS clinical guideline on the pathophysiology and etiology, classification, diagnosis, and management of ankle fractures in adolescents.

Clinical Practice Guideline: Paediatric fracture guidelines - Hip and proximal femur  (2019)

Clinical Practice Guideline: Paediatric fracture guidelines - Hip and proximal femur

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Victorian Paediatric Orthopaedic Network

Victorian Paediatric Orthopaedic Network

Summary and classification of hip and proximal femur fractures.

Summary and classification of hip and proximal femur fractures.

Clincial Practice Guideline: Paediatric fracture guidelines - Femoral shaft (diaphysis)  (2019)

Clincial Practice Guideline: Paediatric fracture guidelines - Femoral shaft (diaphysis)

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Victorian Paediatric Orthopaedic Network

Victorian Paediatric Orthopaedic Network

Summary of femoral shaft fractures, ED management, and follow-up.

Summary of femoral shaft fractures, ED management, and follow-up.

Clincial Practice Guideline: Paediatric fracture guidelines - Tibial shaft (diaphysis)  (2019)

Clincial Practice Guideline: Paediatric fracture guidelines - Tibial shaft (diaphysis)

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Victorian Paediatric Orthopaedic Network

Victorian Paediatric Orthopaedic Network

Summary of tibial shaft fracture, ED management, and follow-up.

Summary of tibial shaft fracture, ED management, and follow-up.

Clinical Practice Guideline: Paediatric fracture guidelines - Ankle (distal tibial and fibula physeal)  (2019)

Clinical Practice Guideline: Paediatric fracture guidelines - Ankle (distal tibial and fibula physeal)

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Victorian Paediatric Orthopaedic Network

Victorian Paediatric Orthopaedic Network

Summary of distal tibia and-or fibula physeal fractures, ED management, and follow-up.

Summary of distal tibia and-or fibula physeal fractures, ED management, and follow-up.

Clinical Practice Guideline: Treatment of Pediatric Diaphyseal Femur Fractures  (2015)

Clinical Practice Guideline: Treatment of Pediatric Diaphyseal Femur Fractures

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Jevsevar DS & Shea K

Jevsevar DS & Shea K

This is an AAOS clinical guideline on the treatment of pediatric diaphyseal femur fractures (PDFF).

This is an AAOS clinical guideline on the treatment of pediatric diaphyseal femur fractures (PDFF).

Clinical Practice Guideline: Management of Pediatric Supracondylar Humerus Fractures with Vascular Injury  (2016)

Clinical Practice Guideline: Management of Pediatric Supracondylar Humerus Fractures with Vascular Injury

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Sanders JO, Heggeness MH, Murray JN, Pezold RC, Sevarino KS

Sanders JO, Heggeness MH, Murray JN, Pezold RC, Sevarino KS

Evidence-based information, in conjunction with the clinical expertise of physicians, was used to develop the criteria to improve patient care and obtain the best outcomes while considering the subtleties and distinctions necessary in making clinical decisions for pediatric supracondylar humerus fractures with vascular injury.

Evidence-based information, in conjunction with the clinical expertise of physicians, was used to develop the criteria to improve patient care and obtain the best outcomes while considering the subtleties and distinctions necessary in making clinical decisions for pediatric supracondylar humerus fractures with vascular injury.

Clinical Practice Guideline: Paediatric fracture guidelines - Proximal humerus  (2017)

Clinical Practice Guideline: Paediatric fracture guidelines - Proximal humerus

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Victorian Paediatric Orthopaedic Network

Victorian Paediatric Orthopaedic Network

Most proximal humeral fractures do not require reduction as remodelling is extremely effective in the proximal humerus. The usual treatment for this fracture is immobilisation of the shoulder in a sling, body swathe or shoulder immobiliser. Patients should be seen in the fracture clinic or by an interested GP within 7 days for follow-up with x-rays to assess further displacement.

Most proximal humeral fractures do not require reduction as remodelling is extremely effective in the proximal humerus. The usual treatment for this fracture is immobilisation of the shoulder in a sling, body swathe or shoulder immobiliser. Patients should be seen in the fracture clinic or by an interested GP within 7 days for follow-up with x-rays to assess further displacement.

Clinical Practice Guidelines: Paediatric fracture guidelines - Clavicle  (2017)

Clinical Practice Guidelines: Paediatric fracture guidelines - Clavicle

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Victorian Paediatric Orthopaedic Network

Victorian Paediatric Orthopaedic Network

Summary of fracture type, ED management, and follow-up.

Summary of fracture type, ED management, and follow-up.

Clinical Practice Guidelines: Paediatric fracture guidelines - Humeral shaft (diaphysis)  (2017)

Clinical Practice Guidelines: Paediatric fracture guidelines - Humeral shaft (diaphysis)

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Victorian Paediatric Orthopaedic Network

Victorian Paediatric Orthopaedic Network

Reduction is seldom required for humeral shaft fractures. Fractures will usually "hang out" (i.e. under influence of gravity) to good alignment and apposition using a collar and cuff. Mid-shaft humeral fractures should be followed up in fracture clinic at 1 week. Spiral fractures of the humerus in toddler age and younger are strongly linked with non-accidental injury. Careful history and examination are required to determine the child at risk.

Reduction is seldom required for humeral shaft fractures. Fractures will usually "hang out" (i.e. under influence of gravity) to good alignment and apposition using a collar and cuff. Mid-shaft humeral fractures should be followed up in fracture clinic at 1 week. Spiral fractures of the humerus in toddler age and younger are strongly linked with non-accidental injury. Careful history and examination are required to determine the child at risk.

Clinical Practice Guidelines: AAOS Appropriate Use Criteria: Management of Pediatric Supracondylar Humerus Fractures  (2015)

Clinical Practice Guidelines: AAOS Appropriate Use Criteria: Management of Pediatric Supracondylar Humerus Fractures

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Park MJ, Ho CA, Larson AN

Park MJ, Ho CA, Larson AN

The American Academy of Orthopaedic Surgeons approved appropriate use criteria for the treatment of pediatric supracondylar humerus fractures in an effort to assist the clinician in caring for these injuries.

The American Academy of Orthopaedic Surgeons approved appropriate use criteria for the treatment of pediatric supracondylar humerus fractures in an effort to assist the clinician in caring for these injuries.

Clinical Practice Guidelines: Management of Pediatric Supracondylar Humerus Fractures  (2015)

Clinical Practice Guidelines: Management of Pediatric Supracondylar Humerus Fractures

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Heggeness MH, Sanders JO, Murray J, Pezold R, Sevarino KS

Heggeness MH, Sanders JO, Murray J, Pezold R, Sevarino KS

The American Academy of Orthopaedic Surgeons has developed Appropriate Use Criteria on the Management of Pediatric Supracondylar Humerus Fractures (PSHF). Evidence-based information, in conjunction with the clinical expertise of physicians, was used to develop the criteria to improve patient care and obtain the best outcomes while considering the subtleties and distinctions necessary in making clinical decisions

The American Academy of Orthopaedic Surgeons has developed Appropriate Use Criteria on the Management of Pediatric Supracondylar Humerus Fractures (PSHF). Evidence-based information, in conjunction with the clinical expertise of physicians, was used to develop the criteria to improve patient care and obtain the best outcomes while considering the subtleties and distinctions necessary in making clinical decisions

Clinical Practice Guidelines: The treatment of pediatric supracondylar humerus fractures  (2012)

Clinical Practice Guidelines: The treatment of pediatric supracondylar humerus fractures

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Howard A, Mulpuri K, Abel MF, Braun S, Bueche M, Epps H, Hosalkar H, Mehlman CT, Scherl S, Goldberg M, Turkelson CM, Wies JL, Boyer K, American Academy of Or...

Howard A, Mulpuri K, Abel MF, Braun S, Bueche M, Epps H, Hosalkar H, Mehlman ...

Based on the best current evidence and a systematic review of published studies, 14 recommendations have been created to guide clinical practice and management of supracondylar fractures of the humerus in children.

Based on the best current evidence and a systematic review of published studies, 14 recommendations have been created to guide clinical practice and management of supracondylar fractures of the humerus in children.

Clinical Practice Guidelines: The treatment of pediatric supracondylar humerus fractures: Evidence-Based Guideline and Evidence Report  (2011)

Clinical Practice Guidelines: The treatment of pediatric supracondylar humerus fractures: Evidence-Based Guideline and Evidence Report

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Howard A, Mulpuri K, Abel MF, Braun S, Bueche M, Epps H, Hosalkar H, Mehlman CT, Scherl S, Goldberg M, Turkelson CM, Wies JL, Boyer K; American Academy of Or...

Howard A, Mulpuri K, Abel MF, Braun S, Bueche M, Epps H, Hosalkar H, Mehlman ...

This clinical practice guideline is based on a systematic review of published studies on the treatment of supracondylar fractures of the humerus in children. In addition to providing practice recommendations, this guideline highlights gaps in the literature and areas that require future research.

This clinical practice guideline is based on a systematic review of published studies on the treatment of supracondylar fractures of the humerus in children. In addition to providing practice recommendations, this guideline highlights gaps in the literature and areas that require future research.

Clinical Practice Guidelines: Treatment of Distal Radius Fractures: Guideline and Evidence Report  (2009)

Clinical Practice Guidelines: Treatment of Distal Radius Fractures: Guideline and Evidence Report

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Lichtman DM, Randipsingh RR, Boyer MI, Putnam MD, Ring D, Slutsky DJ, Taras JS

Lichtman DM, Randipsingh RR, Boyer MI, Putnam MD, Ring D, Slutsky DJ, Taras JS

This an an AAOS clinical guideline for pediatric distal radial fractures.

This an an AAOS clinical guideline for pediatric distal radial fractures.

Clinical Practice Guideline: Pediatric Femoral Shaft Fractures  (2005)

Clinical Practice Guideline: Pediatric Femoral Shaft Fractures

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Anglen, JO & Flynn, JM

Anglen, JO & Flynn, JM

This is an AAOS clinical guideline on the pathophysiology, classification, diagnosis, and management of pediatric femoral shaft fractures.

This is an AAOS clinical guideline on the pathophysiology, classification, diagnosis, and management of pediatric femoral shaft fractures.

Summaries of systematic reviews

Cochrane Summary: Different methods of treating fractures of the shaft of the thigh bone in children and adolescents  (2014)

Cochrane Summary: Different methods of treating fractures of the shaft of the thigh bone in children and adolescents

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Madhuri, V, Dutt, V, Gahukamble, AD & Tharyan, P

Madhuri, V, Dutt, V, Gahukamble, AD & Tharyan, P

Objective: To assess the effects (benefits and harms) of interventions for treating femoral shaft fractures in children and adolescents.

Objective: To assess the effects (benefits and harms) of interventions for treating femoral shaft fractures in children and adolescents.

Overviews of systematic reviews

Cochrane Summary: Surgical treatment for forearm fractures in children (fractures involving the shafts of the radius and ulna)  (2011)

Cochrane Summary: Surgical treatment for forearm fractures in children (fractures involving the shafts of the radius and ulna)

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Abraham A, Kumar S, Chaudhry S, Ibrahim T

Abraham A, Kumar S, Chaudhry S, Ibrahim T

Fractures of the shafts of the forearm bones in children are common injuries and occur after a fall on an outstretched hand. There are two bones in the forearm: the radius and the ulna. After a fall either one or both bones may fracture. The shape of forearm bones are important for the twisting motion of the hand, such as in receiving change from a shop keeper with an open palm (supination) or turning a key in a door (turning the palm facing down - pronation). Treatment of the forearm fracture aims to restore the shape of the bones such that supination and pronation ability is restored. The first stage of treatment involves manipulating (setting) the bones to the correct shape. This is usually done under anaesthesia. The second stage involves stabilising the fractured bones either with a plaster cast (conservative treatment) or metal implants (surgical treatment). This review aimed to examine the evidence from randomised controlled trials comparing conservative versus surgical methods and trials comparing different surgical methods for treatment of these fractures. We hoped to find which are the best methods in terms of function and complications. In spite of a thorough search we found no evidence from properly conducted studies to help inform decisions on treatment of these fractures.

Fractures of the shafts of the forearm bones in children are common injuries and occur after a fall on an outstretched hand. There are two bones in the forearm: the radius and the ulna. After a fall either one or both bones may fracture. The shape of forearm bones are important for the twisting motion of the hand, such as in receiving change from a shop keeper with an open palm (supination) or turning a key in a door (turning the palm facing down - pronation). Treatment of the forearm fracture aims to restore the shape of the bones such that supination and pronation ability is restored. The first stage of treatment involves manipulating (setting) the bones to the correct shape. This is usually done under anaesthesia. The second stage involves stabilising the fractured bones either with a plaster cast (conservative treatment) or metal implants (surgical treatment). This review aimed to examine the evidence from randomised controlled trials comparing conservative versus surgical methods and trials comparing different surgical methods for treatment of these fractures. We hoped to find which are the best methods in terms of function and complications. In spite of a thorough search we found no evidence from properly conducted studies to help inform decisions on treatment of these fractures.

Cochrane Summary: Conservative interventions for shaft fractures of the forearm bones in children  (2013)

Cochrane Summary: Conservative interventions for shaft fractures of the forearm bones in children

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Madhuri V, Dutt V, Gahukamble AD, Tharyan P

Madhuri V, Dutt V, Gahukamble AD, Tharyan P

The forearm consists of two bones, the radius and the ulna. Fractures (broken bones) in the middle portion (shaft) of one or both of these bones are common injuries in children. Most of these fractures are treated conservatively (i.e. without surgery). Conservative treatment usually involves gently putting the broken bone back into place (reduction). Part of the arm is then put in a cast to protect and support the broken bones while they heal. There are different ways of immobilising the injured arm. For example, some casts include the elbow whereas others do not. When casts include the elbow, the elbow may be in a bent or extended position. While these fractures usually heal, the results are not always satisfactory and sometimes there are complications. This review aimed to find out which conservative treatment methods give the best results for children with these fractures by looking at the evidence from randomised controlled trials comparing different conservative interventions. While we found two completed trials, both were published only in conference abstracts that failed to provide any usable data. We also found two ongoing trials. In all, the review found no evidence from randomised trials to inform on the best ways to treat these fractures.

The forearm consists of two bones, the radius and the ulna. Fractures (broken bones) in the middle portion (shaft) of one or both of these bones are common injuries in children. Most of these fractures are treated conservatively (i.e. without surgery). Conservative treatment usually involves gently putting the broken bone back into place (reduction). Part of the arm is then put in a cast to protect and support the broken bones while they heal. There are different ways of immobilising the injured arm. For example, some casts include the elbow whereas others do not. When casts include the elbow, the elbow may be in a bent or extended position. While these fractures usually heal, the results are not always satisfactory and sometimes there are complications. This review aimed to find out which conservative treatment methods give the best results for children with these fractures by looking at the evidence from randomised controlled trials comparing different conservative interventions. While we found two completed trials, both were published only in conference abstracts that failed to provide any usable data. We also found two ongoing trials. In all, the review found no evidence from randomised trials to inform on the best ways to treat these fractures.

Systematic reviews

Cochrane Systematic Review: Oxygen therapy for lower respiratory tract infections in children between 3 months and 15 years of age

Cochrane Systematic Review: Oxygen therapy for lower respiratory tract infections in children between 3 months and 15 years of age

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Rojas MX, Granados Rugeles C, Charry-Anzola LP.

Rojas MX, Granados Rugeles C, Charry-Anzola LP.

Objectives: To determine in the treatment of LRTIs: the effectiveness of oxygen therapy and oxygen delivery methods; the safety of these methods; and indications for oxygen therapy.

Objectives: To determine in the treatment of LRTIs: the effectiveness of oxygen therapy and oxygen delivery methods; the safety of these methods; and indications for oxygen therapy.

Cochrane Systematic Review: Ribavirin for respiratory syncytial virus infections of the lower respiratory tract in infants and young children

Cochrane Systematic Review: Ribavirin for respiratory syncytial virus infections of the lower respiratory tract in infants and young children

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Ventre K, Randolph A.

Ventre K, Randolph A.

Objectives: The objective of this review is to assess the efficacy of aerosolized ribavirin for infants and children with lower respiratory tract infections due to RSV.

Objectives: The objective of this review is to assess the efficacy of aerosolized ribavirin for infants and children with lower respiratory tract infections due to RSV.

Cochrane Systematic Review: Antibiotics for treating lower urinary tract infection in children

Cochrane Systematic Review: Antibiotics for treating lower urinary tract infection in children

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Fitzgerald A, Mori R, Lakhanpaul M, Tullus K

Fitzgerald A, Mori R, Lakhanpaul M, Tullus K

OBJECTIVES: This review aims to summarise the benefits and harms of antibiotics for treating lower UTI in children.

OBJECTIVES: This review aims to summarise the benefits and harms of antibiotics for treating lower UTI in children.

Cochrane Systematic Review: Acetylcysteine and carbocysteine for acute upper and lower respiratory tract infections in paediatric patients without chronic broncho-pulmonary disease

Cochrane Systematic Review: Acetylcysteine and carbocysteine for acute upper and lower respiratory tract infections in paediatric patients without chronic broncho-pulmonary disease

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Chalumeau M, Duijvestijn YC

Chalumeau M, Duijvestijn YC

OBJECTIVES: The objective was to assess the efficacy and safety and to establish a benefit-risk ratio of acetylcysteine and carbocysteine as symptomatic treatments for acute upper and lower RTIs in paediatric patients without chronic broncho-pulmonary disease.

OBJECTIVES: The objective was to assess the efficacy and safety and to establish a benefit-risk ratio of acetylcysteine and carbocysteine as symptomatic treatments for acute upper and lower RTIs in paediatric patients without chronic broncho-pulmonary disease.

Cochrane Systematic Review: Antibiotics for community-acquired lower respiratory tract infections secondary to Mycoplasma pneumoniae in children

Cochrane Systematic Review: Antibiotics for community-acquired lower respiratory tract infections secondary to Mycoplasma pneumoniae in children

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Mulholland S, Gavranich JB, Gillies MB, Chang AB

Mulholland S, Gavranich JB, Gillies MB, Chang AB

OBJECTIVES: To determine whether antibiotics are effective in the treatment of childhood LRTI secondary to M. pneumoniae infections acquired in the community.

OBJECTIVES: To determine whether antibiotics are effective in the treatment of childhood LRTI secondary to M. pneumoniae infections acquired in the community.

Cochrane Systematic Review: Chest radiograph for acute lower respiratory infections

Cochrane Systematic Review: Chest radiograph for acute lower respiratory infections

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Swingler GH, Zwarenstein M

Swingler GH, Zwarenstein M

OBJECTIVES: To assess the effects of chest radiography on clinical outcome in acute lower respiratory infections.

OBJECTIVES: To assess the effects of chest radiography on clinical outcome in acute lower respiratory infections.

Cochrane Systematic Review: Antibiotics for preventing infection in open limb fractures

Cochrane Systematic Review: Antibiotics for preventing infection in open limb fractures

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Gosselin RA, Roberts I, Gillespie WJ

Gosselin RA, Roberts I, Gillespie WJ

OBJECTIVES: To quantify the evidence for the effectiveness of antibiotics in the initial treatment of open fractures of the limbs.

OBJECTIVES: To quantify the evidence for the effectiveness of antibiotics in the initial treatment of open fractures of the limbs.

Cochrane Systematic Review: Conservative interventions for treating middle third clavicle fractures in adolescents and adults

Cochrane Systematic Review: Conservative interventions for treating middle third clavicle fractures in adolescents and adults

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Lenza M, Belloti JC, Andriolo RB, Faloppa F

Lenza M, Belloti JC, Andriolo RB, Faloppa F

OBJECTIVES: To evaluate the effects of different methods for conservative (non-operative) treatment for acute (treated soon after injury) middle third clavicle fractures in adolescents and adults.

OBJECTIVES: To evaluate the effects of different methods for conservative (non-operative) treatment for acute (treated soon after injury) middle third clavicle fractures in adolescents and adults.

Cochrane Systematic Review: Interventions for treating wrist fractures in children

Cochrane Systematic Review: Interventions for treating wrist fractures in children

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Abraham A, Handoll HH, Khan T

Abraham A, Handoll HH, Khan T

OBJECTIVES: We aimed to evaluate removable splintage versus plaster casts (requiring removal by a specialist) for undisplaced compression (buckle) fractures; cast length and position; and the role of surgical fixation for displaced wrist fractures in children.

OBJECTIVES: We aimed to evaluate removable splintage versus plaster casts (requiring removal by a specialist) for undisplaced compression (buckle) fractures; cast length and position; and the role of surgical fixation for displaced wrist fractures in children.

Cochrane Systematic Review: Surgical interventions for diaphyseal fractures of the radius and ulna in children

Cochrane Systematic Review: Surgical interventions for diaphyseal fractures of the radius and ulna in children

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Abraham A, Kumar S, Chaudhry S, Ibrahim T

Abraham A, Kumar S, Chaudhry S, Ibrahim T

OBJECTIVES: To assess the effects (benefits and harms) of a) surgical versus non-surgical interventions, and b) different surgical interventions for the fixation of diaphyseal fractures of the forearm bones in children.

OBJECTIVES: To assess the effects (benefits and harms) of a) surgical versus non-surgical interventions, and b) different surgical interventions for the fixation of diaphyseal fractures of the forearm bones in children.

Cochrane Systematic Review: Surgical interventions for treating acute fractures or non-union of the middle third of the clavicle

Cochrane Systematic Review: Surgical interventions for treating acute fractures or non-union of the middle third of the clavicle

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Lenza M, Belloti JC, Gomes Dos Santos JB, Matsumoto MH, Faloppa F

Lenza M, Belloti JC, Gomes Dos Santos JB, Matsumoto MH, Faloppa F

OBJECTIVES: To evaluate the effectiveness of different methods of surgical treatment for acute fracture or non-union of the middle third of the clavicle.

OBJECTIVES: To evaluate the effectiveness of different methods of surgical treatment for acute fracture or non-union of the middle third of the clavicle.

Cochrane Systematic Review: Surgical versus conservative interventions for treating fractures of the middle third of the clavicle

Cochrane Systematic Review: Surgical versus conservative interventions for treating fractures of the middle third of the clavicle

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Lenza M, Buchbinder R, Johnston RV, Belloti JC, Faloppa F

Lenza M, Buchbinder R, Johnston RV, Belloti JC, Faloppa F

OBJECTIVES: To assess the effects (benefits and harms) of surgical versus conservative interventions for treating middle third clavicle fractures.

OBJECTIVES: To assess the effects (benefits and harms) of surgical versus conservative interventions for treating middle third clavicle fractures.

Cochrane Systematic Review: Antibiotic prophylaxis for preventing meningitis in patients with basilar skull fractures

Cochrane Systematic Review: Antibiotic prophylaxis for preventing meningitis in patients with basilar skull fractures

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Ratilal BO, Costa J, Sampaio C, Pappamikail L

Ratilal BO, Costa J, Sampaio C, Pappamikail L

OBJECTIVES: To evaluate the effectiveness of prophylactic antibiotics for preventing meningitis in patients with BSF.

OBJECTIVES: To evaluate the effectiveness of prophylactic antibiotics for preventing meningitis in patients with BSF.

Cochrane Systematic Review: Interventions for treating femoral shaft fractures in children and adolescents  (2014)

Cochrane Systematic Review: Interventions for treating femoral shaft fractures in children and adolescents

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Madhuri, V, Dutt, V, Gahukamble, AD & Tharyan, P

Madhuri, V, Dutt, V, Gahukamble, AD & Tharyan, P

Objective: To assess the effects (benefits and harms) of interventions for treating femoral shaft fractures in children and adolescents.

Objective: To assess the effects (benefits and harms) of interventions for treating femoral shaft fractures in children and adolescents.

Systematic Review: Accuracy of Ottawa Ankle Rules to exclude fractures of the ankle and midfoot in children: a meta-analysis  (2009)

Systematic Review: Accuracy of Ottawa Ankle Rules to exclude fractures of the ankle and midfoot in children: a meta-analysis

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Dowling, S, Spooner, CH, Liang, Y, Dryden, DM, Friesen, C, Klassen, TP & Wright, RB

Dowling, S, Spooner, CH, Liang, Y, Dryden, DM, Friesen, C, Klassen, TP & ...

Objective: To conduct a systematic review to determine the diagnostic accuracy of the Ottawa Ankle Rules (OAR) to exclude ankle and midfoot fractures in children and the extent to which x-ray use could be reduced without missing significant fractures.

Objective: To conduct a systematic review to determine the diagnostic accuracy of the Ottawa Ankle Rules (OAR) to exclude ankle and midfoot fractures in children and the extent to which x-ray use could be reduced without missing significant fractures.

Systematic Review: Age- and severity-adjusted treatment of proximal humerus fractures in children and adolescents-A systematical review and meta-analysis  (2017)

Systematic Review: Age- and severity-adjusted treatment of proximal humerus fractures in children and adolescents-A systematical review and meta-analysis

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Hohloch L, Eberbach H, Wagner FC, Strohm PC, Reising K, Sdkamp NP, Zwingmann J

Hohloch L, Eberbach H, Wagner FC, Strohm PC, Reising K, Sdkamp NP, Zwingmann J

The aim of this systematic review was to gather the best evidence of different treatment methods and their associated functional outcome, complication rates, rates of limb length discrepancies and radiological outcome for proximal humerus fractures in children and adolescents.

The aim of this systematic review was to gather the best evidence of different treatment methods and their associated functional outcome, complication rates, rates of limb length discrepancies and radiological outcome for proximal humerus fractures in children and adolescents.

Systematic Review: Outcomes of Nonoperative Pediatric Medial Humeral Epicondyle Fractures With and Without Associated Elbow Dislocation  (2017)

Systematic Review: Outcomes of Nonoperative Pediatric Medial Humeral Epicondyle Fractures With and Without Associated Elbow Dislocation

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Knapik DM, Fausett CL, Gilmore A, Liu RW

Knapik DM, Fausett CL, Gilmore A, Liu RW

This systematic review provides a comparative investigation assessing outcomes after nonoperative treatment based on the presence or absence of elbow islocation.

This systematic review provides a comparative investigation assessing outcomes after nonoperative treatment based on the presence or absence of elbow islocation.

Review: When is it ok to use a splint versus cast and what remodeling can one expect for common pediatric forearm fractures  (2017)

Review: When is it ok to use a splint versus cast and what remodeling can one expect for common pediatric forearm fractures

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Runyon RS, Doyle SM

Runyon RS, Doyle SM

The purpose of this review is to provide an overview of common pediatric forearm fractures, clarify the descriptions used to identify and therby appropriately treat them with a splint or cast, and explain osseous remodeling that is unique to the skeletally immature.

The purpose of this review is to provide an overview of common pediatric forearm fractures, clarify the descriptions used to identify and therby appropriately treat them with a splint or cast, and explain osseous remodeling that is unique to the skeletally immature.

Systematic Review: Management Modalities and Outcomes Following Acute Scaphoid Fractures in Children: A Quantitative Review and Meta-Analysis  (2017)

Systematic Review: Management Modalities and Outcomes Following Acute Scaphoid Fractures in Children: A Quantitative Review and Meta-Analysis

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Shaterian A, Santos PJF, Lee CJ, Evans GRD, Leis A

Shaterian A, Santos PJF, Lee CJ, Evans GRD, Leis A

The objective of this study was to compare clinical outcomes following different treatment modalities for pediatric scaphoid fractures.

The objective of this study was to compare clinical outcomes following different treatment modalities for pediatric scaphoid fractures.

Systematic Review: Plate Fixation Versus Nonoperative Treatment for Displaced Midshaft Clavicular Fractures: A Meta-Analysis of Randomized Controlled Trials  (2017)

Systematic Review: Plate Fixation Versus Nonoperative Treatment for Displaced Midshaft Clavicular Fractures: A Meta-Analysis of Randomized Controlled Trials

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Woltz S, Krijnen P, Schipper IB

Woltz S, Krijnen P, Schipper IB

The aim was to analyze whether patients with a displaced midshaft clavicular fracture are best managed with plate fization or nonoperative treatment with respect to nonunion, secondary operations, and functional outcome, by evaluating all available randomized controlled trials on this subject.

The aim was to analyze whether patients with a displaced midshaft clavicular fracture are best managed with plate fization or nonoperative treatment with respect to nonunion, secondary operations, and functional outcome, by evaluating all available randomized controlled trials on this subject.

Review: Buckle fractures of the distal radius in children  (2016)

Review: Buckle fractures of the distal radius in children

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Ben-Yakov M, Boutis K

Ben-Yakov M, Boutis K

This study describes treatment options for buckle fractures of the distal radius in children.

This study describes treatment options for buckle fractures of the distal radius in children.

Systematic Review: A systematic review of alternative splinting versus complete plaster casts for the management of childhood buckle fractures of the wrist  (2016)

Systematic Review: A systematic review of alternative splinting versus complete plaster casts for the management of childhood buckle fractures of the wrist

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Hill CE, Masters JP, Perry DC

Hill CE, Masters JP, Perry DC

A systematic review was performed to analyze the complications of alternatic splinting compared to traditional management.

A systematic review was performed to analyze the complications of alternatic splinting compared to traditional management.

Systematic Review: Management of Pediatric Forearm Torus Fractures: A Systematic Review and Meta-Analysis  (2016)

Systematic Review: Management of Pediatric Forearm Torus Fractures: A Systematic Review and Meta-Analysis

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Jiang N, Cao ZH, Ma YF, Lin Z, Yu B

Jiang N, Cao ZH, Ma YF, Lin Z, Yu B

The aim of this study was to compare, in a systematic review, clinical efficacy of rigid cast with nonrigid methods for immobilization of the pediatric forearm torus fractures.

The aim of this study was to compare, in a systematic review, clinical efficacy of rigid cast with nonrigid methods for immobilization of the pediatric forearm torus fractures.

Systematic Review: Ultrasound in the Diagnostics of Metaphyseal Forearm Fractures in Children: A Systematic Review and Cost Calculation  (2016)

Systematic Review: Ultrasound in the Diagnostics of Metaphyseal Forearm Fractures in Children: A Systematic Review and Cost Calculation

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Katzer C, Wasem J, Eckert K, Ackermann O, Buchberger B

Katzer C, Wasem J, Eckert K, Ackermann O, Buchberger B

This is a systematic review of clinical studies evaluating ultrasound as a possible alternative to radiographs in diagnosing metaphyseal forearm fractures in children.

This is a systematic review of clinical studies evaluating ultrasound as a possible alternative to radiographs in diagnosing metaphyseal forearm fractures in children.

Systematic Review: Outcomes of Nonoperative Treatment of Salter-Harris II Distal Radius Fractures: A Systematic Review  (2016)

Systematic Review: Outcomes of Nonoperative Treatment of Salter-Harris II Distal Radius Fractures: A Systematic Review

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Larsen MC, Bohm KC, Rizkala AR, Ward CM

Larsen MC, Bohm KC, Rizkala AR, Ward CM

This systematic review was conducted of studies examining the radiographic and clinical outcomes of nonoperatively managed SH II distal radius fractures.

This systematic review was conducted of studies examining the radiographic and clinical outcomes of nonoperatively managed SH II distal radius fractures.

Cochrane Systematic Review: Conservative interventions for treating middle third clavicle fractures in adolescents and adults  (2016)

Cochrane Systematic Review: Conservative interventions for treating middle third clavicle fractures in adolescents and adults

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Lenza M, Faloppa F

Lenza M, Faloppa F

The objective was to evaluate the effects (benefits and harms) of different methods for conservative (non-operative) treatment for acute (treated soon after injury) middle third clavicle fractures in adolescents and adults.

The objective was to evaluate the effects (benefits and harms) of different methods for conservative (non-operative) treatment for acute (treated soon after injury) middle third clavicle fractures in adolescents and adults.

Review: Pediatric and Adolescent Forearm Fractures: Current Controversies and Treatment Recommendations  (2016)

Review: Pediatric and Adolescent Forearm Fractures: Current Controversies and Treatment Recommendations

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Pace JL

Pace JL

Pediatric and adolescent forearm fractures continue to present treatment challenges. Despite high-level evidence to the contrary, traditional guidelines for nonsurgical treatment have been challenged in favor of surgical intervention, but it is unclear if this results in improved outcomes. Recent evidence suggests that certain open fractures in children may be successfully treated nonsurgically. Good results have been achieved with closed reduction and appropriate casting and clinical follow-up. Further research investigating functional outcomes into adulthood is needed

Pediatric and adolescent forearm fractures continue to present treatment challenges. Despite high-level evidence to the contrary, traditional guidelines for nonsurgical treatment have been challenged in favor of surgical intervention, but it is unclear if this results in improved outcomes. Recent evidence suggests that certain open fractures in children may be successfully treated nonsurgically. Good results have been achieved with closed reduction and appropriate casting and clinical follow-up. Further research investigating functional outcomes into adulthood is needed

Systematic Review: The treatment of displaced supracondylar humerus fractures: evidence-based guideline  (2012)

Systematic Review: The treatment of displaced supracondylar humerus fractures: evidence-based guideline

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Mulpuri K, Wilkins K

Mulpuri K, Wilkins K

The purpose of this paper is to summarize and highlight the major findings from the systematic review that developed a clinical practice guideline from the American Academy of Orthopaedic Surgeons regarding treatment for type III supracondylar fractures.

The purpose of this paper is to summarize and highlight the major findings from the systematic review that developed a clinical practice guideline from the American Academy of Orthopaedic Surgeons regarding treatment for type III supracondylar fractures.

Cochrane Systematic Review: Surgical interventions for diaphyseal fractures of the radius and ulna in children  (2011)

Cochrane Systematic Review: Surgical interventions for diaphyseal fractures of the radius and ulna in children

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Abraham A, Kumar S, Chaudhry S, Ibrahim T

Abraham A, Kumar S, Chaudhry S, Ibrahim T

The objective was to assess the effects (benefits and harms) of a) surgical versus non-surgical interventions, and b) different surgical interventions for the fixation of diaphyseal fractures of the forearm bones in children.

The objective was to assess the effects (benefits and harms) of a) surgical versus non-surgical interventions, and b) different surgical interventions for the fixation of diaphyseal fractures of the forearm bones in children.

Systematic Review: Above- or below-elbow casts for distal third forearm fractures in children? A meta-analysis of the literature  (2011)

Systematic Review: Above- or below-elbow casts for distal third forearm fractures in children? A meta-analysis of the literature

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Hendrickx RP, Campo MM, van Lieshout AP, Struijs PA, van den Bekerom MP

Hendrickx RP, Campo MM, van Lieshout AP, Struijs PA, van den Bekerom MP

The purpose of this meta-analysis is to investigate whether above- or below-elbow cast should be considered the first-choice for conservative treatment.

The purpose of this meta-analysis is to investigate whether above- or below-elbow cast should be considered the first-choice for conservative treatment.

Systematic Review: Conservative Management of Minimally Displaced (2 mm) Fractures of the Lateral Humeral Condyle in Pediatric Patients: A Systematic Review  (2017)

Systematic Review: Conservative Management of Minimally Displaced (2 mm) Fractures of the Lateral Humeral Condyle in Pediatric Patients: A Systematic Review

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Knapik DM, Gilmore A, Liu RW

Knapik DM, Gilmore A, Liu RW

This systematic review aims to provide the ideal treatment for minimally displaced fractures (measuring ≤2 mm)

 

This systematic review aims to provide the ideal treatment for minimally displaced fractures (measuring ≤2 mm)

 

Systematic Review: Use of point-of-care ultrasound in long bone fractures: a systematic review and meta-analysis  (2017)

Systematic Review: Use of point-of-care ultrasound in long bone fractures: a systematic review and meta-analysis

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Chartier, L B, Bosco, L, Lapointe-Shaw, L and Chenkin, J

Chartier, L B, Bosco, L, Lapointe-Shaw, L and Chenkin, J

This article offers a comprehensive review of the use of PoCUS for the diagnosis and reduction of LBFs.

This article offers a comprehensive review of the use of PoCUS for the diagnosis and reduction of LBFs.

Key studies

Key Study: Altered lower extremity fracture characteristics in obese pediatric trauma patients  (2015)

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

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

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.

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

Key Study: Patient and Parent Satisfaction With Sling Use After Pediatric Upper Extremity Fractures: A Randomized Controlled Trial of a Customized Cast-sling Versus Standard Cast and Sling  (2017)

Key Study: Patient and Parent Satisfaction With Sling Use After Pediatric Upper Extremity Fractures: A Randomized Controlled Trial of a Customized Cast-sling Versus Standard Cast and Sling

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Cruz AI Jr, DeFroda SF, Gil JA, Hansen H, Bolous A, Procaccini M, Zonfrillo MR

Cruz AI Jr, DeFroda SF, Gil JA, Hansen H, Bolous A, Procaccini M, Zonfrillo MR

The purpose of this investigation was to compare patient/parent centered outcomes after the use of a customized sling compared with a standard sling by utilizing a prospective, randomized-controlled trial.

The purpose of this investigation was to compare patient/parent centered outcomes after the use of a customized sling compared with a standard sling by utilizing a prospective, randomized-controlled trial.

Key Study: Functional outcome after air-stirrup ankle brace or fiberglass backslab for pediatric low-risk ankle fractures: a randomized observer-blinded controlled trial  (2012)

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

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

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.

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: A randomized, controlled trial of a removable brace versus casting in children with low-risk ankle fractures  (2007)

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

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

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.

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: Cost analysis and performance in distal pediatric forearm fractures: is a short-arm cast superior to a sugar-tong splint?  (2017)

Key Study: Cost analysis and performance in distal pediatric forearm fractures: is a short-arm cast superior to a sugar-tong splint?

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Acree JS, Schlechter J, Buzin S

Acree JS, Schlechter J, Buzin S

The aim of this study is to compare splint versus cast immobilization for maintaining alignment following closed reduction of distal 1/3 radius and both-bone forearm fractures.

The aim of this study is to compare splint versus cast immobilization for maintaining alignment following closed reduction of distal 1/3 radius and both-bone forearm fractures.

Key Study: Do All Clavicle Fractures in Children Need To Be Managed by Orthopedic Surgeons?  (2018)

Key Study: Do All Clavicle Fractures in Children Need To Be Managed by Orthopedic Surgeons?

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Adamich, J, Howard, A and Camp, M

Adamich, J, Howard, A and Camp, M

Development of an evidence-based clinical care pathway can help unnecessary radiation exposure to this patient population and reduce costs to patient families and the health care system.

Development of an evidence-based clinical care pathway can help unnecessary radiation exposure to this patient population and reduce costs to patient families and the health care system.

Key Study: Bivalved Versus Circumferential Cast Immobilization for Displaced Forearm Fractures: A Randomized Clinical Trial to Assess Efficacy and Safety  (2017)

Key Study: Bivalved Versus Circumferential Cast Immobilization for Displaced Forearm Fractures: A Randomized Clinical Trial to Assess Efficacy and Safety

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Bae DS, Valim C, Connell P, Brustowicz KA, Waters PM

Bae DS, Valim C, Connell P, Brustowicz KA, Waters PM

The purpose of this study was to determine the effects of bivalved versus circumferential cast immobilization on maintenance of reduction and associated complications after closed reduction of radius and/or ulna fractures in children.

The purpose of this study was to determine the effects of bivalved versus circumferential cast immobilization on maintenance of reduction and associated complications after closed reduction of radius and/or ulna fractures in children.

Key Study: Valve or No Valve: A Prospective Randomized Controlled Trial of Casting Options for Pediatric Forearm Fractures  (2017)

Key Study: Valve or No Valve: A Prospective Randomized Controlled Trial of Casting Options for Pediatric Forearm Fractures

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Baldwin PC III, Han E, Parrino A, Solomito MJ, Lee MC

Baldwin PC III, Han E, Parrino A, Solomito MJ, Lee MC

The purpose of this study was to determine the rate of cast-related complications when using split or intact casts.

The purpose of this study was to determine the rate of cast-related complications when using split or intact casts.

Key Study: Adolescent Distal Humerus Fractures: ORIF Versus CRPP  (2017)

Key Study: Adolescent Distal Humerus Fractures: ORIF Versus CRPP

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Bell P, Scannell BP, Loeffler BJ, Brighton BK, Gaston RG, Casey V, Peters ME, Frick S, Cannada L, Vanderhave KL

Bell P, Scannell BP, Loeffler BJ, Brighton BK, Gaston RG, Casey V, Peters ME,...

The purpose of this study was to review the treatment and outcomes of consecutive series of distal humerus fractures in adolescents and to compare outcomes between patients treated with percutaneous skeletal fixation and those treated with open reduction and fixation.

The purpose of this study was to review the treatment and outcomes of consecutive series of distal humerus fractures in adolescents and to compare outcomes between patients treated with percutaneous skeletal fixation and those treated with open reduction and fixation.

Key Study: Intravenous regional anaesthesia (Bier's block) for pediatric forearm fractures in a pediatric emergency department-Experience from 2003 to 2014  (2017)

Key Study: Intravenous regional anaesthesia (Bier's block) for pediatric forearm fractures in a pediatric emergency department-Experience from 2003 to 2014

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Chua ISY, Chong SL, Ong GYK

Chua ISY, Chong SL, Ong GYK

The objective of the study was to evaluate the efficacy (length of stay in the emergency department and failure rate of Bier's block) and safety profile (death and major complications) of Bier's block in its use for manipulation and reduction of paediatric forearm fractures.

The objective of the study was to evaluate the efficacy (length of stay in the emergency department and failure rate of Bier's block) and safety profile (death and major complications) of Bier's block in its use for manipulation and reduction of paediatric forearm fractures.

Key Study: Obesity Increases Risk of Loss of Reduction after Casting for Diaphyseal Fractures of the Radius and Ulna in Children: An Observational Cohort Study  (2017)

Key Study: Obesity Increases Risk of Loss of Reduction after Casting for Diaphyseal Fractures of the Radius and Ulna in Children: An Observational Cohort Study

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DeFrancesco CJ, Rogers BH, Shah AS

DeFrancesco CJ, Rogers BH, Shah AS

The objective of this study was to determine if high body mass index increases the risk of loss of reduction following closed reduction and casting for displaced concomitant fractures of the radial and ulnar shafts in pediatric patients.

The objective of this study was to determine if high body mass index increases the risk of loss of reduction following closed reduction and casting for displaced concomitant fractures of the radial and ulnar shafts in pediatric patients.

Key Study: The utility of clinical ultrasonography in identifying distal forearm fractures inthe pediatric emergency department  (2017)

Key Study: The utility of clinical ultrasonography in identifying distal forearm fractures inthe pediatric emergency department

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Galletebeitia Laka I, Samson F, Gorostiza I, Gonzalez A, Gonzalez C

Galletebeitia Laka I, Samson F, Gorostiza I, Gonzalez A, Gonzalez C

The aim of this study is to evaluate the utility of point-of-care ultrasound for diagnosing distal forearm fractures in pediatric emergency departments.

The aim of this study is to evaluate the utility of point-of-care ultrasound for diagnosing distal forearm fractures in pediatric emergency departments.

Key Study: Reducing resource utilization during non-operative treatment of pediatric proximal humerus fractures  (2017)

Key Study: Reducing resource utilization during non-operative treatment of pediatric proximal humerus fractures

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Gladstein AZ, Schade AT, Howard AW, Camp MW

Gladstein AZ, Schade AT, Howard AW, Camp MW

The primary outcome of the study was the proportion of proximal humerus fractures, initially treated non-operatively, for which displacement or angulation on follow-up radiographs led to a change to operative treatment.

The primary outcome of the study was the proportion of proximal humerus fractures, initially treated non-operatively, for which displacement or angulation on follow-up radiographs led to a change to operative treatment.

Key Study: The Use of Magnetic Resonance Imaging in Management of Minimally Displaced or Nondisplaced Lateral Humeral Condyle Fractures in Children  (2017)

Key Study: The Use of Magnetic Resonance Imaging in Management of Minimally Displaced or Nondisplaced Lateral Humeral Condyle Fractures in Children

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Haillotte G, Bachy M, Delpont M, Kabbaj R, Ducou le Pointe H, Vialle R

Haillotte G, Bachy M, Delpont M, Kabbaj R, Ducou le Pointe H, Vialle R

The purpose of this study was to investigate the use of MRI in diagnosis and therapeutic decision in minimally displaced lateral condyle fractures in children.

The purpose of this study was to investigate the use of MRI in diagnosis and therapeutic decision in minimally displaced lateral condyle fractures in children.

Key Study: Minimal training sufficient to diagnose pediatric wrist fractures with ultrasound  (2017)

Key Study: Minimal training sufficient to diagnose pediatric wrist fractures with ultrasound

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Hedelin H, Tingstrm C, Hebelka H, Karlsson J

Hedelin H, Tingstrm C, Hebelka H, Karlsson J

The aim of this study was to evaluate the role of ultrasound (US) as a point-of-care triage tool for pediatric wrist injuries with limited training.

The aim of this study was to evaluate the role of ultrasound (US) as a point-of-care triage tool for pediatric wrist injuries with limited training.

Key Study: Functional outcomes following non-operative versus operative treatment of clavicle fractures in adolescents  (2017)

Key Study: Functional outcomes following non-operative versus operative treatment of clavicle fractures in adolescents

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Herzog MM, Whitesell RC, Mac LM, Jackson ML, Culotta BA, Axelrod JR, Busch MT, Willimon SC

Herzog MM, Whitesell RC, Mac LM, Jackson ML, Culotta BA, Axelrod JR, Busch MT...

This study aimed to assess shoulder function in adolescents following shortened clavicle fracture and compare operative versus non-operative treatment.

This study aimed to assess shoulder function in adolescents following shortened clavicle fracture and compare operative versus non-operative treatment.

Key Study: Emerging U.S. National Trends in the Treatment of Pediatric Supracondylar Humeral Fractures  (2017)

Key Study: Emerging U.S. National Trends in the Treatment of Pediatric Supracondylar Humeral Fractures

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Holt JB, Glass NA, Bedard NA, Weinstein SL, Shah AS

Holt JB, Glass NA, Bedard NA, Weinstein SL, Shah AS

Understanding national treatment trends will provide important insight into variations in regional treatment standards and help identify areas for improvement in value in care delivery.

Understanding national treatment trends will provide important insight into variations in regional treatment standards and help identify areas for improvement in value in care delivery.

Key Study: Procedural Sedation With Ketamine Versus Propofol for Closed Reduction of Pediatric Both Bone Forearm Fractures  (2017)

Key Study: Procedural Sedation With Ketamine Versus Propofol for Closed Reduction of Pediatric Both Bone Forearm Fractures

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Morrison T, Carender C, Kilbane B, Liu RW

Morrison T, Carender C, Kilbane B, Liu RW

The current study was conducted to answer 2 questions for pediatric both bone forearm fractures treated with closed reduction with either ketamine or propofol procedural sedation : 1) Is there a difference in the rate of unacceptable alignment 4 weeks after reduction? 2) Is there a difference in the rates of major sedation-related complications?

The current study was conducted to answer 2 questions for pediatric both bone forearm fractures treated with closed reduction with either ketamine or propofol procedural sedation : 1) Is there a difference in the rate of unacceptable alignment 4 weeks after reduction? 2) Is there a difference in the rates of major sedation-related complications?

Key Study: Capitellar Fractures in Children and Adolescents: Classification and Early Results of Treatment  (2017)

Key Study: Capitellar Fractures in Children and Adolescents: Classification and Early Results of Treatment

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Murthy PG, Vuillermin C, Naqvi MN, Waters PM, Bae DS

Murthy PG, Vuillermin C, Naqvi MN, Waters PM, Bae DS

The purpose of this investigation was to characterize capitellar fracture patterns in children and adolescents and to assess early clinical and radiographic treatment outcomes.

The purpose of this investigation was to characterize capitellar fracture patterns in children and adolescents and to assess early clinical and radiographic treatment outcomes.

Key Study: Point-of-care Ultrasound for Nonangulated Distal Forearm Fractures in Children: Test Performance Characteristics and Patient-centered Outcomes  (2017)

Key Study: Point-of-care Ultrasound for Nonangulated Distal Forearm Fractures in Children: Test Performance Characteristics and Patient-centered Outcomes

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Poonai N, Myslik F, Joubert G, Fan J, Misir A, Istasy V, Columbus M, Soegtrop R, Goldfarb A, Thompson D, Dubrovsky AS

Poonai N, Myslik F, Joubert G, Fan J, Misir A, Istasy V, Columbus M, Soegtrop...

The objectives of the study were to examine the test performance characteristics of point-of-care ultrasound for nonangulated distal forearm injuries in children and compare to x-ray with respect to pain, caregiver satisfaction, and procedure duration.

The objectives of the study were to examine the test performance characteristics of point-of-care ultrasound for nonangulated distal forearm injuries in children and compare to x-ray with respect to pain, caregiver satisfaction, and procedure duration.

Key Study: Bedside Ultrasound vs X-Ray for the Diagnosis of Forearm Fractures in Children  (2017)

Key Study: Bedside Ultrasound vs X-Ray for the Diagnosis of Forearm Fractures in Children

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Rowlands R, Rippey J, Tie S, Flynn J

Rowlands R, Rippey J, Tie S, Flynn J

The primary aim of this study was to determine if a cohort of physicians with little or no previous experience with US could, after a short training program, safely exclude forearm fractures in children.

The primary aim of this study was to determine if a cohort of physicians with little or no previous experience with US could, after a short training program, safely exclude forearm fractures in children.

Key Study: Relevance of MRI for management of non-displaced lateral humeral condyle fractures in children  (2017)

Key Study: Relevance of MRI for management of non-displaced lateral humeral condyle fractures in children

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Thvenin-Lemoine C, Salanne S, Pham T, Accadbled F, Baunin C, Sales De Gauzy J

Thvenin-Lemoine C, Salanne S, Pham T, Accadbled F, Baunin C, Sales De Gauzy J

The primary objective of this study was to evaluate the ability of MRI to determine whether the fracture line is complete or incomplete in cases of non-displaced lateral humeral condyle fractures in children.

The primary objective of this study was to evaluate the ability of MRI to determine whether the fracture line is complete or incomplete in cases of non-displaced lateral humeral condyle fractures in children.

Key Study: Childhood Obesity Increases the Risk of Failure in the Treatment of Distal Forearm Fractures  (2016)

Key Study: Childhood Obesity Increases the Risk of Failure in the Treatment of Distal Forearm Fractures

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Auer RT, Mazzone P, Robinson L, Nyland J, Chan G

Auer RT, Mazzone P, Robinson L, Nyland J, Chan G

A retrospective case-controlled study was conducted to determine whether obesity is an independent risk factor for the failure of closed reduction and casting.

A retrospective case-controlled study was conducted to determine whether obesity is an independent risk factor for the failure of closed reduction and casting.

Key Study: Influence of Immobilization Time on Functional Outcome in Radial Neck Fractures in Children  (2016)

Key Study: Influence of Immobilization Time on Functional Outcome in Radial Neck Fractures in Children

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Badoi A, Frech-Drfler M, Hcker FM, Mayr J

Badoi A, Frech-Drfler M, Hcker FM, Mayr J

The aim of the study was to analyze the influence of immobilization time on functional outcome.

The aim of the study was to analyze the influence of immobilization time on functional outcome.

Key Study: Functional Outcomes After Treatment of Scaphoid Fractures in Children and Adolescents  (2016)

Key Study: Functional Outcomes After Treatment of Scaphoid Fractures in Children and Adolescents

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Bae DS, Gholson JJ, Zurakowski D, Waters PM

Bae DS, Gholson JJ, Zurakowski D, Waters PM

The purpose of this investigation was to characterize the functional outcomes of children and adolescents treated for scaphoid fractures.

The purpose of this investigation was to characterize the functional outcomes of children and adolescents treated for scaphoid fractures.

Key Study: Forearm-Based Ulnar Gutter versus Hand-Based Thermoplastic Splint for Pediatric Metacarpal Neck Fractures: A Blinded, Randomized Trial  (2016)

Key Study: Forearm-Based Ulnar Gutter versus Hand-Based Thermoplastic Splint for Pediatric Metacarpal Neck Fractures: A Blinded, Randomized Trial

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Davison PG, Boudreau N, Burrows R, Wilson KL, Bezuhly M

Davison PG, Boudreau N, Burrows R, Wilson KL, Bezuhly M

Primary outcome of this study was the difference in active range of motion between a conventional forearm-based ulnar gutter or hand-based thermoplastic splint.

Primary outcome of this study was the difference in active range of motion between a conventional forearm-based ulnar gutter or hand-based thermoplastic splint.

Key Study: MRI shows a high incidence of carpal fractures in children with posttraumatic radial-sided wrist tenderness  (2016)

Key Study: MRI shows a high incidence of carpal fractures in children with posttraumatic radial-sided wrist tenderness

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Jrgsholm P, Thomsen N, Besjakov J, Abrahamsson S, Bjrkman A

Jrgsholm P, Thomsen N, Besjakov J, Abrahamsson S, Bjrkman A

This study describes fractures revealed by magnetic resonance imaging (MRI) in a prospective population of children and adolescents with posttraumatic radial-sided wrist tenderness, and compare the diagnostic value of radiographs and computed tomography (CT) with that of MRI.

This study describes fractures revealed by magnetic resonance imaging (MRI) in a prospective population of children and adolescents with posttraumatic radial-sided wrist tenderness, and compare the diagnostic value of radiographs and computed tomography (CT) with that of MRI.

Key Study: Primary Care Physician Follow-up of Distal Radius Buckle Fractures  (2016)

Key Study: Primary Care Physician Follow-up of Distal Radius Buckle Fractures

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Koelink E, Schuh S, Howard A, Stimec J, Barra L, Boutis K

Koelink E, Schuh S, Howard A, Stimec J, Barra L, Boutis K

The main objective was to determine the proportion of children referred to a primary care provider (PCP) for follow-up of a distal radius buckle fracture who subsequently did not deviate from this reassessment strategy.

The main objective was to determine the proportion of children referred to a primary care provider (PCP) for follow-up of a distal radius buckle fracture who subsequently did not deviate from this reassessment strategy.

Key Study: Manipulation and reduction of paediatric fractures of the distal radius and forearm using intranasal diamorphine and 50% oxygen and nitrous oxide in the emergency department: a 2.5-year study  (2016)

Key Study: Manipulation and reduction of paediatric fractures of the distal radius and forearm using intranasal diamorphine and 50% oxygen and nitrous oxide in the emergency department: a 2.5-year study

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Kurien T, Price KR, Pearson RG, Dieppe C, Hunter JB

Kurien T, Price KR, Pearson RG, Dieppe C, Hunter JB

This study presents the results of managing children's fracture of the distal forearm in the ED using intranasal diamorphine and Entonox to allow manipulation and discharge on the same day.

This study presents the results of managing children's fracture of the distal forearm in the ED using intranasal diamorphine and Entonox to allow manipulation and discharge on the same day.

Key Study: Acute ischemia and pink pulseless hand in 68 of 404 gartland type III supracondylar humeral fractures in children: Urgent management and therapeutic consensus  (2016)

Key Study: Acute ischemia and pink pulseless hand in 68 of 404 gartland type III supracondylar humeral fractures in children: Urgent management and therapeutic consensus

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Louahem D, Cottalorda J

Louahem D, Cottalorda J

The purpose of this retrospective study was to describe our strategy and to determine the guidelines of therapeutic consensus.

The purpose of this retrospective study was to describe our strategy and to determine the guidelines of therapeutic consensus.

Key Study: Radiographic Evaluation During Treatment of Pediatric Forearm Fractures: Implications on Clinical Care and Cost  (2016)

Key Study: Radiographic Evaluation During Treatment of Pediatric Forearm Fractures: Implications on Clinical Care and Cost

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Luther G, Miller P, Waters PM, Bae DS

Luther G, Miller P, Waters PM, Bae DS

The purpose of this study was to analyze the clinical utility and cost of the week 4 radiograph following closed treatment of pediatric forearm fractures.

The purpose of this study was to analyze the clinical utility and cost of the week 4 radiograph following closed treatment of pediatric forearm fractures.

Key Study: Introduction of a simple guideline to improve neurological assessment in paediatric patients presenting with upper limb fractures  (2016)

Key Study: Introduction of a simple guideline to improve neurological assessment in paediatric patients presenting with upper limb fractures

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Marsh AG, Robertson JS, Godman A, Boyle J, Huntley JS

Marsh AG, Robertson JS, Godman A, Boyle J, Huntley JS

This study aimed to assess the improvement in documented neurological examination for children presenting with upper limb fractures following introduction of a simple guideline.

This study aimed to assess the improvement in documented neurological examination for children presenting with upper limb fractures following introduction of a simple guideline.

Key Study: Effect of a Computerized Reminder on Splinting of Pediatric Upper Limb Fractures in the Emergency Department  (2016)

Key Study: Effect of a Computerized Reminder on Splinting of Pediatric Upper Limb Fractures in the Emergency Department

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Mills E, Craig S, Oakley E

Mills E, Craig S, Oakley E

The primary objective was to assess if a computerized pop-up reminder increased splint application before X-ray in pediatric emergency department patients with deformed upper limb fractures.

The primary objective was to assess if a computerized pop-up reminder increased splint application before X-ray in pediatric emergency department patients with deformed upper limb fractures.

Key Study: Is softcast (3M) strong enough for potentially unstable paediatric forearm fractures?  (2016)

Key Study: Is softcast (3M) strong enough for potentially unstable paediatric forearm fractures?

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Patel N, Wilson L, Wansbrough G

Patel N, Wilson L, Wansbrough G

This study aimed to investigate whether the mechanical properties of Softcast are sufficient to stabilize a paediatric forearm fracture and protect the patient from further injury against clinically defined failure parameters.

This study aimed to investigate whether the mechanical properties of Softcast are sufficient to stabilize a paediatric forearm fracture and protect the patient from further injury against clinically defined failure parameters.

Key Study: Postsplinting x-rays of nondisplaced hand, wrist, ankle, and foot fractures are unnecessary  (2016)

Key Study: Postsplinting x-rays of nondisplaced hand, wrist, ankle, and foot fractures are unnecessary

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Schuld JC, Volker ML, Anderson SA, Zwank MD

Schuld JC, Volker ML, Anderson SA, Zwank MD

The objectives of this study were to determine how often X-rays are obtained after splinting of non-displaced fractures to identify if postsplinting X-rays change treatment management in the ED, and identify if there are medical complications at follow-up.

The objectives of this study were to determine how often X-rays are obtained after splinting of non-displaced fractures to identify if postsplinting X-rays change treatment management in the ED, and identify if there are medical complications at follow-up.

Key Study: Reducing Cost and Radiation Exposure During the Treatment of Pediatric Greenstick Fractures of the Forearm  (2016)

Key Study: Reducing Cost and Radiation Exposure During the Treatment of Pediatric Greenstick Fractures of the Forearm

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Ting BL, Kalish LA, Waters PM, Bae DS

Ting BL, Kalish LA, Waters PM, Bae DS

The purpose of this investigtion was to evaluate the LOR rate requiring intervention - including either repeat closed reduction or surgical reduction and fixation- following closed reduction and cast immobilization of pediatric greenstick forearm fractures.

The purpose of this investigtion was to evaluate the LOR rate requiring intervention - including either repeat closed reduction or surgical reduction and fixation- following closed reduction and cast immobilization of pediatric greenstick forearm fractures.

Key Study: Long-term Functional Results of Neurological Complications of Pediatric Humeral Supracondylar Fractures  (2016)

Key Study: Long-term Functional Results of Neurological Complications of Pediatric Humeral Supracondylar Fractures

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Valencia M, Moraleda L, Dez-Sebastin J

Valencia M, Moraleda L, Dez-Sebastin J

The aim of this study is to report the long-term functional outcome of neurological complications associated to pediatric supracondylar fractures.

The aim of this study is to report the long-term functional outcome of neurological complications associated to pediatric supracondylar fractures.

Key Study: Using softcast to treat torus fractures in a paediatric emergency department  (2015)

Key Study: Using softcast to treat torus fractures in a paediatric emergency department

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Callender O, Koe S

Callender O, Koe S

Wrist torus fractures in children are a frequent reason for Emergency Department (ED) visits. Torus fractures traditionally were treated with a backslab cast in the Children's ED and then referred to the Fracture Clinic. Guidelines were developed in order to standardise the care for children who attended the ED with a torus fracture. All patients who were seen & treated by the Advanced Nurse Practitioner (ANP) over a one year period with a diagnosis of a torus fracture were treated with immobilisation in a softcast. 119 patients met the criteria for inclusion. There were no adverse events recorded and no patient required subsequent visits to the Fracture Clinic. There was a cost savings of 18,596 as compared with the normal referral pathway to the Fracture Clinic.

Wrist torus fractures in children are a frequent reason for Emergency Department (ED) visits. Torus fractures traditionally were treated with a backslab cast in the Children's ED and then referred to the Fracture Clinic. Guidelines were developed in order to standardise the care for children who attended the ED with a torus fracture. All patients who were seen & treated by the Advanced Nurse Practitioner (ANP) over a one year period with a diagnosis of a torus fracture were treated with immobilisation in a softcast. 119 patients met the criteria for inclusion. There were no adverse events recorded and no patient required subsequent visits to the Fracture Clinic. There was a cost savings of 18,596 as compared with the normal referral pathway to the Fracture Clinic.

Key Study: Feasibility of a reduction protocol in the emergency department for diaphyseal forearm fractures in children  (2015)

Key Study: Feasibility of a reduction protocol in the emergency department for diaphyseal forearm fractures in children

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Pesenti S, Litzelmann E, Kahil M, Mallet C, Jehanno P, Mercier JC, Ilharreborde B, Mazda K

Pesenti S, Litzelmann E, Kahil M, Mallet C, Jehanno P, Mercier JC, Ilharrebor...

The purpose of this study was to analyze the results of diaphyseal forearm fractures in the emergency department in children.

The purpose of this study was to analyze the results of diaphyseal forearm fractures in the emergency department in children.

Key Study: Accuracy of ultrasonography for determining successful realignment of pediatric forearm fractures  (2014)

Key Study: Accuracy of ultrasonography for determining successful realignment of pediatric forearm fractures

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Dubrovsky AS, Kempinska A, Bank I, Mok E

Dubrovsky AS, Kempinska A, Bank I, Mok E

The primary objective of this study is to assess the accuracy of point-of-care ultrasonography compared with blinded orthopedic assessment of fluroscoppy in determining successful realignment of pediatric forearm fractures.

The primary objective of this study is to assess the accuracy of point-of-care ultrasonography compared with blinded orthopedic assessment of fluroscoppy in determining successful realignment of pediatric forearm fractures.

Key Study: Synthetic versus plaster of Paris casts in the treatment of fractures of the forearm in children: a randomised trial of clinical outcomes and patient satisfaction  (2013)

Key Study: Synthetic versus plaster of Paris casts in the treatment of fractures of the forearm in children: a randomised trial of clinical outcomes and patient satisfaction

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Inglis M, McClelland B, Sutherland LM, Cundy PJ

Inglis M, McClelland B, Sutherland LM, Cundy PJ

The aim of this study was to investigate which cast material is superior for the management of fractures of the forearm.

The aim of this study was to investigate which cast material is superior for the management of fractures of the forearm.

Key Study: Below-elbow cast for metaphyseal both-bone fractures of the distal forearm in children: a randomised multicentre study  (2012)

Key Study: Below-elbow cast for metaphyseal both-bone fractures of the distal forearm in children: a randomised multicentre study

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Colaris JW, Biter LU, Allema JH, Bloem RM, van de Ven CP, de Vries MR, Kerver AJ, Reijman M, Verhaar JA

Colaris JW, Biter LU, Allema JH, Bloem RM, van de Ven CP, de Vries MR, Kerver...

The purpose of this study was to find out whether below-elbow casts cause equal limitation of pronation and supination but with higher comfort level, compared with above-elbow casts.

The purpose of this study was to find out whether below-elbow casts cause equal limitation of pronation and supination but with higher comfort level, compared with above-elbow casts.

Key Study: Bedside ultrasound in the diagnosis of pediatric clavicle fractures  (2011)

Key Study: Bedside ultrasound in the diagnosis of pediatric clavicle fractures

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Chien M, Bulloch B, Garcia-Filion P, Youssfi M, Shrader MW, Segal LS

Chien M, Bulloch B, Garcia-Filion P, Youssfi M, Shrader MW, Segal LS

The objective of this study was to determine the diagnostic accuracy of pediatric emergency physicians in diagnosing clavicle fractures by bedside ultrasound.

The objective of this study was to determine the diagnostic accuracy of pediatric emergency physicians in diagnosing clavicle fractures by bedside ultrasound.

Key Study: Cast versus splint in children with minimally angulated fractures of the distal radius: a randomized controlled trial  (2010)

Key Study: Cast versus splint in children with minimally angulated fractures of the distal radius: a randomized controlled trial

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Boutis K, Willan A, Babyn P, Goeree R, Howard A

Boutis K, Willan A, Babyn P, Goeree R, Howard A

This study aimed to determine whether the use of a prefabricated splint is as effective as a cast in the recovery of physical function.

This study aimed to determine whether the use of a prefabricated splint is as effective as a cast in the recovery of physical function.

Key Study: A randomized, controlled trial of removable splinting versus casting for wrist buckle fractures in children  (2006)

Key Study: A randomized, controlled trial of removable splinting versus casting for wrist buckle fractures in children

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Plint AC, Perry JJ, Correll R, Gaboury I, Lawton L

Plint AC, Perry JJ, Correll R, Gaboury I, Lawton L

The objective of this study was to determine if children with distal radius and/or ulna buckle fractures treated with a removable splint have better physical functioning than those treated with a short arm cast for 3 weeks.

The objective of this study was to determine if children with distal radius and/or ulna buckle fractures treated with a removable splint have better physical functioning than those treated with a short arm cast for 3 weeks.

Key Study: Simple treatment for torus fractures of the distal radius  (2001)

Key Study: Simple treatment for torus fractures of the distal radius

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Davidson JS, Brown DJ, Barnes SN, Bruce CE

Davidson JS, Brown DJ, Barnes SN, Bruce CE

Based on the results of a postal questionnaire and a prospective randomised trial, this study descibes a simple treatement for a torus fracture of the distal radius, which saves both time and money.

Based on the results of a postal questionnaire and a prospective randomised trial, this study descibes a simple treatement for a torus fracture of the distal radius, which saves both time and money.

Key Study: Do toddler's fractures of the tibia require evaluation and management by an orthopaedic surgeon routinely?  (2018)

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

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Adamich, J S and Camp, M W

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.

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  (2018)

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

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Schuman, S S, Regen, R B, Stuart, L H, Harrell, C, Jones, T L, Stewart, B M, Berg, A M, Longjohn, M and Kink, R J

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.

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  (2017)

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

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Roaten, J D, Kelly, D M, Yellin, J L, Flynn, J M, Cyr, M, Garg, S, Broom, A, Andras, L M and Sawyer, J R

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).

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?  (2017)

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

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

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.

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: Expedited Delivery of Pain Medication for Long-Bone Fractures Using an Intranasal Fentanyl Clinical Pathway  (2015)

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

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

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.

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: Emergency room closed reduction versus in situ splinting in the treatment of paediatric supracondylar humerus fractures  (2019)

Key Study: Emergency room closed reduction versus in situ splinting in the treatment of paediatric supracondylar humerus fractures

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Sylvia, SM, Maguire, KJ, Molho, DA, Levens, BJ, Stone, MEJ, Hanstein, R, Schulz, JF and Fornari, ED

Sylvia, SM, Maguire, KJ, Molho, DA, Levens, BJ, Stone, MEJ, Hanstein, R, Schu...

The purpose of this study was to investigate if outcomes or complications differ between two management methods.

The purpose of this study was to investigate if outcomes or complications differ between two management methods.

Key Study: Pediatric Forearm Fractures Are Effectively Immobilized With a Sugar-Tong Splint Following Closed Reduction  (2019)

Key Study: Pediatric Forearm Fractures Are Effectively Immobilized With a Sugar-Tong Splint Following Closed Reduction

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Dittmer, AJ, Molina, D 4th Jacobs, CA, Walker, J and Muchow, RD

Dittmer, AJ, Molina, D 4th Jacobs, CA, Walker, J and Muchow, RD

Following closed reduction and initial casting of pediatric forearm fractures, loss of reduction (LOR) occurs in 5% to 75% of fractures. We hypothesized that the sugar-tong splint would be an acceptable method for initial immobilization to prevent LOR in distal, mid-shaft, and proximal pediatric forearm fractures.

Following closed reduction and initial casting of pediatric forearm fractures, loss of reduction (LOR) occurs in 5% to 75% of fractures. We hypothesized that the sugar-tong splint would be an acceptable method for initial immobilization to prevent LOR in distal, mid-shaft, and proximal pediatric forearm fractures.

Key Study: Point-of-care ultrasound compared with conventional radiographic evaluation in children with suspected distal forearm fractures in the Netherlands: a diagnostic accuracy study  (2019)

Key Study: Point-of-care ultrasound compared with conventional radiographic evaluation in children with suspected distal forearm fractures in the Netherlands: a diagnostic accuracy study

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Epema, AC, Spanjer, MJB, Ras, L, Kelder, JC and Sanders, M

Epema, AC, Spanjer, MJB, Ras, L, Kelder, JC and Sanders, M

The primary objective was to determine the accuracy of US, performed by a Dutch EP, compared with conventional radiography, in diagnosing distal forearm fractures in children. As a secondary objective, differences in pain scores during the performance of both US and plain radiography were determined.

The primary objective was to determine the accuracy of US, performed by a Dutch EP, compared with conventional radiography, in diagnosing distal forearm fractures in children. As a secondary objective, differences in pain scores during the performance of both US and plain radiography were determined.

Key Study: Management of Paediatric Buckle (Torus) Wrist Fractures in Irish Emergency Departments: A National Survey  (2018)

Key Study: Management of Paediatric Buckle (Torus) Wrist Fractures in Irish Emergency Departments: A National Survey

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Abdelhady, A, Ahmed, A, Umana, E and O'Donnell, J

Abdelhady, A, Ahmed, A, Umana, E and O'Donnell, J

Buckle fractures are the most common wrist fractures reported in the paediatric age group. National Institute for Clinical Excellence (NICE) recommends using a non-rigid immobilisation with no follow up for these patients and appropriate discharge advice. A telephone survey was conducted to assess the variation in practice in Irish hospitals regarding the mpediatrianagement of buckle fractures.

Buckle fractures are the most common wrist fractures reported in the paediatric age group. National Institute for Clinical Excellence (NICE) recommends using a non-rigid immobilisation with no follow up for these patients and appropriate discharge advice. A telephone survey was conducted to assess the variation in practice in Irish hospitals regarding the mpediatrianagement of buckle fractures.

Key Study: Scaphoid Fractures in Children: Do We Need to X-ray? A Retrospective Chart Review of 144 Wrists  (2018)

Key Study: Scaphoid Fractures in Children: Do We Need to X-ray? A Retrospective Chart Review of 144 Wrists

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Porter, J, Porter, R and Chan, KJ

Porter, J, Porter, R and Chan, KJ

The purpose of this study is to determine the predictive value of clinical suspicion for scaphoid fracture in children aged 4 to 11 years, to look at the efficiency and practicality of current management of children presenting to the emergency department, and to help quantify the burden of the treatment strategy of immobilization for 10 to 14 days on clinical grounds despite negative or equivocal x-rays on presentation.

The purpose of this study is to determine the predictive value of clinical suspicion for scaphoid fracture in children aged 4 to 11 years, to look at the efficiency and practicality of current management of children presenting to the emergency department, and to help quantify the burden of the treatment strategy of immobilization for 10 to 14 days on clinical grounds despite negative or equivocal x-rays on presentation.

Key Study: Pediatric Supracondylar Humerus Fractures: AAOS Appropriate Use Criteria Versus Actual Management at a Pediatric Level 1 Trauma Center  (2017)

Key Study: Pediatric Supracondylar Humerus Fractures: AAOS Appropriate Use Criteria Versus Actual Management at a Pediatric Level 1 Trauma Center

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Wang, JH, Morris, WZ, Bafus, BT and Liu, RW

Wang, JH, Morris, WZ, Bafus, BT and Liu, RW

The purpose of this study was to characterize management of supracondylar humerus fractures (SCHFs) at a level 1 trauma center and identify factors contributing to divergence in management from American Academy of Orthopedic Surgeons (AAOS) the Appropriate Use Criteria (AUC) recommendations.

The purpose of this study was to characterize management of supracondylar humerus fractures (SCHFs) at a level 1 trauma center and identify factors contributing to divergence in management from American Academy of Orthopedic Surgeons (AAOS) the Appropriate Use Criteria (AUC) recommendations.

Key Study: A comparison of intervention and conservative treatment for angulated fractures of the distal forearm in children (AFIC): study protocol for a randomized controlled trial  (2015)

Key Study: A comparison of intervention and conservative treatment for angulated fractures of the distal forearm in children (AFIC): study protocol for a randomized controlled trial

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Adrian, M, Wachtlin, D, Kronfeld, K, Sommerfeldt, D and Wessel, LM

Adrian, M, Wachtlin, D, Kronfeld, K, Sommerfeldt, D and Wessel, LM

The primary objective of this trial is to assess whether or not the long-term functional outcome in remodeling patients is inferior to patients receiving closed reduction and K-wire pinning.

The primary objective of this trial is to assess whether or not the long-term functional outcome in remodeling patients is inferior to patients receiving closed reduction and K-wire pinning.

Key Study: Hematoma block versus sedation for the reduction of distal radius fractures in children  (2015)

Key Study: Hematoma block versus sedation for the reduction of distal radius fractures in children

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Bear, DM, Friel, NA, Lupo, CL, Pitetti, R and Ward, WT

Bear, DM, Friel, NA, Lupo, CL, Pitetti, R and Ward, WT

To determine which mode of anesthesia, hematoma block (HB) or procedural sedation (PS), was preferable for distal radius fracture (DRF) reduction in children.

To determine which mode of anesthesia, hematoma block (HB) or procedural sedation (PS), was preferable for distal radius fracture (DRF) reduction in children.

Key Study: Is high weight status associated with pediatric forearm fractures requiring anatomic reduction?  (2015)

Key Study: Is high weight status associated with pediatric forearm fractures requiring anatomic reduction?

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Ryan, LM, Teach, SJ, Ezeibe, U, Lall, A, Wood, R and Chamberlain, JM

Ryan, LM, Teach, SJ, Ezeibe, U, Lall, A, Wood, R and Chamberlain, JM

We compared the epidemiology of children's forearm fractures treated with fracture reduction to those not treated with reduction, hypothesizing that high weight status would be significantly associated with need for reduction.

We compared the epidemiology of children's forearm fractures treated with fracture reduction to those not treated with reduction, hypothesizing that high weight status would be significantly associated with need for reduction.

Key Study: Multiple interventions improve analgesic treatment of supracondylar humerus fractures in a pediatric emergency department  (2015)

Key Study: Multiple interventions improve analgesic treatment of supracondylar humerus fractures in a pediatric emergency department

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Porter, RN, Chafe, RE, Newhook, LA and Murnaghan, KD

Porter, RN, Chafe, RE, Newhook, LA and Murnaghan, KD

To measure the effectiveness of a set of interventions in improving the rate and timeliness of analgesic medication administration, as well as appropriate backslab immobilization (application of a moldable plaster or fiberglass splint), in a pediatric ED.

To measure the effectiveness of a set of interventions in improving the rate and timeliness of analgesic medication administration, as well as appropriate backslab immobilization (application of a moldable plaster or fiberglass splint), in a pediatric ED.

Key Study: Effect of the low risk ankle rule on the frequency of radiography in children with ankle injuries  (2013)

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

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Boutis, K, Grootendorst, P, Willan, A, Plint, AC, Babyn, P, Brison, RJ, Sayal, A, Parker, M, Mamen, N, Schuh, S, Grimshaw, J, Johnson, D & Narayanan, U

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.

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

Key Study: Prospective validation and head-to-head comparison of 3 ankle rules in a pediatric population  (2009)

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

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

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.

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

Key Study: Cost Consequence Analysis of Implementing the Low Risk Ankle Rule in Emergency Departments  (2015)

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

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Boutis, K, von Keyserlingk, C, Willan, A, Narayanan, UG, Brison, R, Grootendorst, P, Plint AC, Parker, M & Goeree, R

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.

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

Key Study: Validation of the Ottawa Knee Rule in children: a multicenter study  (2003)

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

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Bulloch, B, Neto, G, Plint, A, Lim, R, Lidman, P, Reed, M, Nijssen-Jordan, C, Tenenbein, M, Klassen, TP, Bhargava, R & Pediatric Emergency Researchers of...

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.

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  (1999)

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

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Plint, AC, Bulloch, B, Osmond, MH, Stiell, I, Dunlap, H, Reed, M, Tenenbein, M & Klassen, TP

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.

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: Radiograph-Negative Lateral Ankle Injuries in Children: Occult Growth Plate Fracture or Sprain?  (2016)

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

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

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.

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.

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New Resources on trekk.ca!

Posted: Nov 13, 2015  | Announcement  | Team: News and Events 


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New Parent Tools- Fractures

Posted: Oct 11, 2022  | Announcement  | Team: News and Events 
Tags: Fractures


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Dr. Amy Plint on wrist buckle fractures

Posted: Oct 06, 2015  | Announcement  | Team: News and Events 


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Updated resources: Fractures Bottom Line Recommendations

Posted: Feb 27, 2018  | Announcement  | Team: News and Events 


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New bottom line recommendations for concussion on trekk.ca

Posted: Nov 05, 2014  | Announcement  | Team: News and Events 


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Predicting the duration of post-concussion symptoms

Posted: Mar 10, 2016  | Announcement  | Team: News and Events 


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Treating Gastroenteritis: Evidence for Clinicians

Posted: Apr 10, 2015  | Announcement  | Team: News and Events 
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