Pediatric Distal Forearm Fractures Clinical Trial
Official title:
Closed Reduction and Cast Immobilization of Distal Radius Fractures by Pediatric Emergency Medicine
Distal forearm fractures are amongst the most frequently encountered orthopedic injuries in
the pediatric emergency department (ED). Immediate closed manipulation and cast
immobilization, is still the mainstay of management. The initial management of non-displaced
or minimally displaced extremity fractures and relocation of uncomplicated joint
dislocations is part of the usual practice of emergency medicine. Although focused training
in fracture-dislocation reduction techniques is a part of the core curriculum of emergency
medicine training programs, there is limited data discussing outcomes following restorative
fracture care by pediatric emergency medicine (PEM)physicians.
The primary objective of this study is to compare length-of-stay and clinical outcomes after
closed manipulation of uncomplicated, isolated, distal forearm fractures, by PEMs to those
after manipulation by pediatric orthopedic surgeons. Our hypothesis is that there is no
difference in emergency department length-of-stay when fracture reduction is performed by a
PEM versus a post graduate year 3 or 4 orthopedic resident. Secondary outcomes that will be
assessed include: loss of reduction needing re-manipulation at follow up, cast related
complications, radiographic and functional healing at 6-8 weeks post injury.
Pediatric forearm fractures are common injuries and a frequent cause for an emergency room
admission. Ward et al have outlined the demands that emergency department coverage places on
practicing orthopedic surgeons. Assuming no statistically significant differences in
outcomes, there are potential advantages of having PEMs provide restorative fracture care at
the initial visit. This practice would permit judicious orthopedic consultation at a time
when several emergency department's are facing an "on call" specialist coverage crisis and
there exists a nationwide shortage of fellowship trained pediatric orthopedic specialists,
in addition to ACGME mandated duty hour restrictions for orthopedic residents.
Pershad et al conducted a retrospective study with historical controls, of 60 patients with
distal radius fracture that were reduced by an orthopedic resident or PEM physician. In this
review, there were no differences in rates of re-intervention to restore fracture alignment
or ED length-of-stay between the two groups.Mean facility charges were lower in the group
treated by PEMs.
It is our hypothesis that with goal directed training, PEM physicians can perform closed
reduction of uncomplicated distal forearm fractures with outcomes that are similar to when
fracture reduction is performed by senior orthopedic resident physicians.
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Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Single Blind (Investigator), Primary Purpose: Health Services Research
| Status | Clinical Trial | Phase | |
|---|---|---|---|
| Not yet recruiting |
NCT05425758 -
Optimal Index for Pediatric Distal Forearm Fractures
|