Pediatric Distal Radial Fractures Treated by Emergency Physicians

Background: The initial management of distal radius fractures in children is part of the usual practice of Emergency Medicine. However, no data are available evaluating the outcome of pediatric forearm fractures that undergo closed reduction and casting by emergency physicians. Study Objective: To assess short-term outcomes after distal forearm fracture reductions performed by emergency physicians. Methods: A retrospective cohort study with matched controls was performed on children with a closed, displaced, or angulated distal forearm fracture that required manipulation. The study group was defined as patients in whom emergency physicians performed closed manipulation and cast immobilization without orthopedic consultation. The control group was defined as patients who had closed reduction by an orthopedic resident. Two controls were identified for each study patient on or around the same date of visit. During the 20-month period, the medical records of 22 study patients and 42 controls were reviewed. The two groups were similar in age, fracture angulation and displacement, and skeletal maturity. Results: All patients had acceptable alignment at 3–5-day follow-up. Two study patients and one control required re-manipulation at subsequent follow-up (p = 0.34). All other patients in both groups who were seen at follow-up had satisfactory healing and function at 6–8 weeks after injury. Three study patients and 4 controls had an unscheduled outpatient visit to the Emergency Department (ED) for cast-related problems (p = 0.80). None of these patients developed compartment syndrome. The mean length of stay in the ED was lower in the study group than in the control group (3.1 h compared to 5.1 h, respectively; p = 0.0026). The mean facility charge also was lower in the study group ($2182.50 compared to $3031 in the control group; p = 0.0006). Conclusions: Our results suggest that emergency physicians may be able to successfully provide restorative care for distal forearm fractures using closed reduction technique. Care rendered by emergency physicians was associated with a shorter length of stay and lower facility charges.