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Resources in Evidence Repository and Individual Compendia

Bottom Line Recommendations

UNDER REVIEW Bottom Line Recommendations: Fractures

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Boutis K, Camp M & 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.

UNDER REVIEW: Recommandations de Base: Fractures chez l'enfant

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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 2018.

 

Clinical guidelines

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

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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.

Clinical Practice Guideline: Splinting ABCs: upper and lower extremity splinting in the emergency department

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Sarwark, JF, Maizels, M, Adler, MD & Nicholson, D

This guideline describes preparation and application of plaster and fiberglass short arm splints and short leg splints. Materials and set up for each type of splint are discussed in detail and the advantages and disadvantages of using fiberglass splints are outlined.

POSNA Study Guide: Upper Extremity Topics

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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.

Clinical Practice Guideline: Paediatric fracture guidelines

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Victorian Paediatric Orthopaedic Network

Summary of paediatric fracture types, emergency department management, and information for fracture clinics.

Clinical Practice Guideline: Management of fractures in adolescents

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Parikh, SN, Wells, L, Mehlman, CT & Scherl, SA

Summary of classifications, imaging, and treatments of fractures.

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, Mathe...

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

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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.

Clincial Practice Guideline: Ankle Fractures in Adolescents

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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.

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

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Victorian Paediatric Orthopaedic Network

Summary and classification of hip and proximal femur fractures.

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

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Victorian Paediatric Orthopaedic Network

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

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

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Victorian Paediatric Orthopaedic Network

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

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

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Victorian Paediatric Orthopaedic Network

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

Clinical Practice Guideline: Peripheral neurovascular checklist

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SicKids Division of Orthopaedic Surgery

Peripheral Neurovascular Checklist.

Clinical Practice Guideline: Treatment of Pediatric Diaphyseal Femur Fractures

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Jevsevar DS & Shea K

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

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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.

Clinical Practice Guideline: Paediatric fracture guidelines - Proximal humerus

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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.

Clinical Practice Guidelines: Paediatric fracture guidelines - Clavicle

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Victorian Paediatric Orthopaedic Network

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

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

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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.

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

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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.

Clinical Practice Guidelines: Management of Pediatric Supracondylar Humerus Fractures

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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

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 ...

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

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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.

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

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

Clinical Practice Guideline: Pediatric Femoral Shaft Fractures

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Anglen, JO & Flynn, JM

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

Summaries of systematic reviews

Cochrane Summary: Antibiotics for lower urinary tract infection in children

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Fitzgerald A, Mori R, Lakhanpaul M, Tullus K

Urinary tract infection (UTI) is one of the most common bacterial infections in infants and children. The most commonly presenting infection of the urinary tract is known as cystitis and in the majority of cases can be easily treated with a course of antibiotic therapy with no further complications. This review identified 16 studies investigating antibiotics for UTI in children. Results suggest that 10-day antibiotic treatment is more likely to eliminate bacteria from the urine than single-dose treatments; there was not enough data to draw conclusions about other treatment durations, or effectiveness of particular antibiotics. Although antibiotic treatment is effective for children with UTI, there are insufficient data to recommend any specific regimen.

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

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

Cochrane Summary: Antibiotics for preventing infection in open limb fractures

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Gosselin, RA, Roberts, I & Gillespie, WJ

Objective: To review the evidence for the effectiveness of antibiotics in the initial treatment of open fractures of the limbs.

Cochrane Summary: Nerve blocks for initial pain management of thigh bone fractures in children

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Black KJ, Bevan CA, Murphy NG, Howard JJ

Fractures (breaks) of the thigh bone can be very painful, particularly when a child arrives in a stressful emergency environment and is undergoing assessment. Moving the child to get X-rays or transferring the child to a special bed to support the leg in traction (keeping the leg straight) can cause additional pain, as can placing traction (a pulling force) on the broken thigh. This means that prompt provision of pain relief is an essential part of initial emergency management. This review investigated whether a nerve block, involving the injection of a freezing/numbing medication at the top of the thigh, would provide more effective pain relief than pain medicine given by mouth or into a vein (intravenously, e.g. morphine). We searched several medical databases and trial registries up to January 2013 and contacted researchers. We found one study that looked at the comparison we were interested in. This study was potentially biased, mainly because the care providers, parents and children were aware of the type of pain relief the children received. The study was small, involving 55 children aged 16 months to 15 years, and showed that the children who received one of the two main types of nerve block tended to have less pain after 30 minutes than those who received intravenous morphine for initial pain control. The nerve blocks led to some pain and redness at the injection site in a few cases, while intravenous morphine caused more serious problems such as depressed breathing (lack of oxygen), excessive sleepiness and vomiting in a small number of children. Moreover, children who had nerve blocks continued to have lower pain scores over a six-hour period with less need for additional pain relief. There was insufficient evidence to determine whether children or parents were more satisfied with one method of pain relief than the other. Use of resources (e.g. nursing time, cost of medications) was not measured. The quality of the study included in this review was low and so these conclusions are not certain. Further well designed studies investigating whether nerve blocks are more effective and safer than other means of pain relief are needed.

Book: Rockwood and Wilkins' Fractures in Children

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Flynn, JM, Skaggs, DL, Waters, PM

Written by leading orthopaedic surgeons from around the world, the revised and expanded 8th edition of this classic bestselling text presents complete, up-to-date coverage of all types of children's fractures.

Overviews of systematic reviews

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

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

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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.

Overview of Systematic Reviews: What does the recent literature add to the identification and investigation of fractures in child abuse: an overview of review updates 2005-2013

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Maguire S, Cowley L, Mann M, Kemp A

Objective: To identify additional studies that contribute to the evidence on distinguishing which fractures are indicative of abuse and optimizing the identification of occult fractures.

Systematic reviews

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.

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

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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.

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

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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.

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

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

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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.

Cochrane Systematic Review: Chest radiograph for acute lower respiratory infections

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Swingler GH, Zwarenstein M

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

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

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Fitzgerald A, Mori R, Lakhanpaul M, Tullus K

This review aims to summarise the benefits and harms of antibiotics for treating lower urinary tract infection in children.

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

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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.

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

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

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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.

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

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

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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.

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

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

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Ratilal BO, Costa J, Sampaio C, Pappamikail L

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

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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.

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 & ...

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.

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

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Gosselin, RA, Roberts, I, & Gillespie, WJ

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

Cochrane Systematic Review: Nerve blocks for initial pain management of femoral fractures in children

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Black KJ, Bevan CA, Murphy NG, Howard JJ

Objectives: To assess the effects (benefits and harms) of femoral nerve block (FNB) or fascia iliaca compartment block (FICB) for initial pain management of children with fractures of the femur (thigh bone) in the pre-hospital or in-hospital emergency setting, with or without systemic analgesia.

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

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

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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.

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

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

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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.

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

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

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Ben-Yakov M, Boutis K

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

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Hill CE, Masters JP, Perry DC

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

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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.

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

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

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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.

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

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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.

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

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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

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

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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.

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

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

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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.

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

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

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

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

 

Systematic Review: Common pediatric fractures treated with minimal intervention

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Boutis, K

This article will review the evidence that recommends that management of some of the most common upper and lower pediatric extremity fractures be treated with minimal interventions, such as removable splints and follow-up with a primary care provider.

Key studies

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

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

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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.

Key Study: Randomized Controlled Feasibility Trial of Intranasal Ketamine Compared to Intranasal Fentanyl for Analgesia in Children with Suspected Extremity Fractures

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Reynolds, S L, Bryant, K K, Studnek, J R, Hogg, M, Dunn, C, Templin, M A, Moo...

We compared the tolerability and efficacy of intranasal subdissociative ketamine to intranasal fentanyl for analgesia of children with acute traumatic pain and investigated the feasibility of a larger noninferiority trial that could investigate the potential opioid-sparing effects of intranasal ketamine.

Key Study: Does the Use of Ibuprofen in Children with Extremity Fractures Increase their Risk for Bone Healing Complications?

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DePeter, K C, Blumberg, S M, Dienstag Becker, S and Meltzer, J A

OBJECTIVE: To determine if exposure to ibuprofen is associated with an increased risk of bone healing complications in children with fractures.

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

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

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

Key Study: Ibuprofen provides analgesia equivalent to acetaminophen-codeine in the treatment of acute pain in children with extremity injuries: a randomized clinical trial

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Friday JH, Kanegaye JT, McCaslin I, Zheng A, Harley JR

Objectives: This study compared the analgesic effectiveness of acetaminophen-codeine with that of ibuprofen for children with acute traumatic extremity pain, with the hypothesis that the two medications would demonstrate equivalent reduction in pain scores in an emergency department (ED) setting.

Key Study: Efficacy and impact of intravenous morphine before surgical consultation in children with right lower quadrant pain suggestive of appendicitis: a randomized controlled trial

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Bailey B, Bergeron S, Gravel J, Bussieres JF, Bensoussan A

Study Objective: The evidence supporting the use of analgesia in children with abdominal pain suggestive of appendicitis is limited. The objectives of the study are to evaluate the efficacy of morphine before surgical consultation in children presenting to the pediatric emergency department (ED) with right lower quadrant pain suggestive of appendicitis and determine whether it has an impact on the time between arrival in the ED and the surgical decision.

Key Study: Early treatment of food-induced anaphylaxis with epinephrine is associated with a lower risk of hospitalization

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Fleming JT, Clark S, Camargo CA Jr, Rudders SA

The objective of this study was to identify factors associated with early epinephrine treatment for FIA and to specifically examine the association between early epinephrine treatment and hospitalization.

Key study: Resumption of physical activity within 7 days of a concussion was associated with lower rates of persistent postconcussive symptoms (PPCS)

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Kanani AN, Hartshorn S.

A planned secondary analysis of nine pediatric emergency departments of return to physical activity within 7 days postinjury (ranging from light exercise to a full return to competitive sports).

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

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

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

Key Study: 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

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

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

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

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

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

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

Key Study: A randomized, 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

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: Ability of emergency ultrasonography to detect pediatric skull fractures: a prospective, observational study

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Parri N, Crosby BJ, Glass C, Mannelli F, Sforzi I, Schiavone R, Ban KM

Our objective was to determine if bedside ED ultrasound is an accurate diagnostic tool for identifying skull fractures when compared toheadCT.

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

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

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

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

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

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

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

Visit

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

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

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

Visit

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

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

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

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Koelink, E, & Boutis, K

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

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

Visit

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

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

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

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

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

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

Visit

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

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

Key Study: Fractures in physical child abuse

Visit

Kemp AM

This review identifies some of the features that can be used to differentiate abusive fractures from the greater numbers of childhood fractures that are sustained from accidental trauma. Current investigation strategies and diagnostic dilemmas are discussed.

Does Severity of Pelvic Fractures Correlate with the Incidence of Associated Intra-Abdominal Injuries in Children?

Visit

Swaid F, Peleg K, Alfici R, Olsha O, Givon A, Kessel B,

A retrospective cohort study involving blunt trauma patients up to the age of 14 years, who suffered from pelvic fractures, with or without associated intra-abdominal injuries.

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

Visit

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.

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

Visit

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.

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

Visit

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.

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

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

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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.

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

Visit

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.

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

Visit

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.

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

Visit

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.

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

Visit

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.

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

Visit

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.

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

Visit

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.

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...

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

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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.

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

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

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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.

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...

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

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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.

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

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

Visit

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.

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

Visit

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.

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

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

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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.

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

Visit

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.

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

Visit

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.

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

Visit

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.

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

Visit

Louahem D, Cottalorda J

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

Visit

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.

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

Visit

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.

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

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?

Visit

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.

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

Visit

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.

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

Visit

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.

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

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

Visit

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.

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

Visit

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.

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

Visit

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.

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

Visit

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.

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

Visit

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.

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

Visit

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.

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

Visit

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.

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

Visit

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.

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

Visit

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.

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

Visit

Adamich, J S and Camp, M W

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

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

Visit

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

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

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

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

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

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

Visit

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

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

Key Study: 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

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

Visit

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.

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

Visit

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.

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

Visit

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.

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

Visit

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.

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

Visit

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.

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

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

Visit

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.

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

Visit

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.

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

Visit

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.

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

Visit

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.

Key Study: Conscious sedation and reduction of fractures in the paediatric population: an orthopaedic perspective

Visit

Yang, B W and Waters, P M

This study describes the epidemiology and outcomes associated with fracture conscious sedation and reduction in a level I paediatric ED.

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

Visit

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

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

Key Study: 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

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

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

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

Key Study: 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,...

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

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

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

Key Study: 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

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.

TREKK.ca Info Pages

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New Resources on trekk.ca!

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



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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 
Tags: Gastroenteritis




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