The aim of this study was to explore clinicians’ experience of a paediatric randomized controlled trial (RCT) comparing surgical reduction with non-surgical casting for displaced distal radius fractures. Overall, 22 staff from 15 hospitals who participated in the RCT took part in an interview. Interviews were informed by phenomenology and analyzed using thematic analysis.Aims
Methods
This exploratory randomized controlled trial (RCT) aimed to determine the splint-related outcomes when using the novel biodegradable wood-composite splint (Woodcast) compared to standard synthetic fibreglass (Dynacast) for the immobilization of undisplaced upper limb fractures in children. An exploratory RCT was performed at a tertiary paediatric referral hospital between 1 June 2018 and 30 September 2019. The intention-to-treat population consisted of 170 patients (mean age 8.42 years (SD 3.42); Woodcast (WCG), n = 84, 57 male (67.9%); Dynacast (DNG), n = 86, 58 male (67.4%)). Patients with undisplaced upper limb fractures were randomly assigned to WCG or DNG treatment groups. Primary outcome was the stress stability of the splint material, defined as absence of any deformations or fractures within the splint during study period. Secondary outcomes included patient satisfaction and medical staff opinion. Additionally, biomechanical and chemical analysis of the splint samples was carried out.Aims
Methods
High-quality clinical research in children’s orthopaedic surgery
has lagged behind other surgical subspecialties. This study used
a consensus-based approach to identify research priorities for clinical
trials in children’s orthopaedics. A modified Delphi technique was used, which involved an initial
scoping survey, a two-round Delphi process and an expert panel formed
of members of the British Society of Children’s Orthopaedic Surgery.
The survey was conducted amongst orthopaedic surgeons treating children
in the United Kingdom and Ireland.Aims
Methods
A retrospective study was performed in 100 children
aged between two and 16 years, with a dorsally angulated stable
fracture of the distal radius or forearm, who were treated with
manipulation in the emergency department (ED) using intranasal diamorphine
and 50% oxygen and nitrous oxide. Pre- and post-manipulation radiographs,
the final radiographs and the clinical notes were reviewed. A successful
reduction was achieved in 90 fractures (90%) and only three children
(3%) required remanipulation and Kirschner wire fixation or internal
fixation. The use of Entonox and intranasal diamorphine is safe and effective
for the closed reduction of a stable paediatric fracture of the
distal radius and forearm in the ED. By facilitating discharge on the same day, there is a substantial
cost benefit to families and the NHS and we recommend this method. Take home message: Simple easily reducible fractures of the distal
radius and forearm in children can be successfully and safely treated
in the ED using this approach, thus avoiding theatre admission and
costly hospital stay. Cite this article:
The management of children’s fractures has evolved
as a result of better health education, changes in lifestyle, improved
implant technology and the changing expectations of society. This
review focuses on the changes seen in paediatric fractures, including
epidemiology, the increasing problems of obesity, the mechanisms
of injury, non-accidental injuries and litigation. We also examine
the changes in the management of fractures at three specific sites:
the supracondylar humerus, femoral shaft and forearm. There has
been an increasing trend towards surgical stabilisation of these
fractures. The reasons for this are multifactorial, including societal
expectations of a perfect result and reduced hospital stay. Reduced hospital
stay is beneficial to the social, educational and psychological
needs of the child and beneficial to society as a whole, due to
reduced costs. Cite this article:
We investigated whether, in the management of
stable paediatric fractures of the forearm, flexible casts that
can be removed at home are as clinically effective Cite this article:
Redisplacement is the most common complication
of immobilisation in a cast for the treatment of diaphyseal fractures
of the forearm in children. We have previously shown that the three-point
index (TPI) can accurately predict redisplacement of fractures of
the distal radius. In this prospective study we applied this index
to assessment of diaphyseal fractures of the forearm in children
and compared it with other cast-related indices that might predict
redisplacement. A total of 76 children were included. Their ages,
initial displacement, quality of reduction, site and level of the
fractures and quality of the casting according to the TPI, Canterbury
index and padding index were analysed. Logistic regression analysis
was used to investigate risk factors for redisplacement. A total
of 18 fractures (24%) redisplaced in the cast. A TPI value of >
0.8 was the only significant risk factor for redisplacement (odds
ratio 238.5 (95% confidence interval 7.063 to 8054.86); p <
0.001). The TPI was far superior to other radiological indices, with
a sensitivity of 84% and a specificity of 97% in successfully predicting
redisplacement. We recommend it for routine use in the management
of these fractures in children. Cite this article:
