In 2000 our emergency department implemented a new management for the treatment of isolated, apex volar distal radial fractures involving immobilisation with a wrist splint, written information for carers and no planned follow up. Next day x-ray review acted as a safety net for misdiagnosed or less stable fractures.

This has now been validated with a retrospective review of treatment for distal radial # within the ED.

Patients were identified through the Emergency department’s electronic discharge record. Over a 9 month period 260 patients were identified with metaphyseal distal radial and/or ulna injuries to which a non orthopaedic junior doctor might be expected to apply the Buckle Fracture Algorithm. Of these 161 had isolated distal radial fractures suitable for treatment with a wrist splint. 118 were correctly identified and treated in the ED. 43 patients were sent to # clinic, of these 11 patients were discharged at the 1st visit, however 3 had 3 or more visits and 2 children had additional x-rays. Over this period 9 children were given splints inappropriately according to the protocol, most of these had stable injuries on reviewing the x-rays, 3 were identified and recalled for a cast. None of the children with injuries outside the protocol who were not recalled had an unplanned return with complications.

Taking into account only those children who were correctly managed from the ED the estimated annual cost savings to the NHS for this hospital for this period is £40,784, compared to standard treatment before introduction of this protocol. If all children had been treated according to protocol the estimated cost savings would be £56096/yr.