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Simple approach to buckle fractures eases strain on EDs

Health

A STREAMLINED pathway for a common childhood fracture that utilises removable splints rather than traditional plaster casts is leading to faster and simpler outcomes for families and hospitals.

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The pathway is designed to provide a more efficient treatment to patients, speed up treatment times in the ED and reduce demand on outpatient services at Flinders Medical Centre and Noarlunga Hospital in South Australia.

 “This is a safe, quicker and more appealing treatment option for young patients and their families,” said Flinders Medical Centre Orthopaedic Nurse Practitioner Cheryl Kimber.

A buckle or “torus” fracture is specific to children, and generally occurs when they fall with outstretched hands while playing sport or climbing on playground equipment.

Hundreds of children present each year to Emergency Departments with the injury in Adelaide, the South Australian capital.

Traditionally, treatment involves placing the injured limb in a plaster cast and then returning numerous times to the Outpatient Department for review, further castings, x-rays and then finally, removal of the cast. 

During the healing process the cast must remain dry – making bathing and showering difficult.

However, a study carried out in the Flinders Medical Centre ED last year found that removable splints were just as effective as plaster casts – and had benefits for both patient and hospital.

“Children’s bones have a different structure to adult bones and thus are more likely to buckle or bend than break. The bone is injured, but instead of being snapped it is squashed. Unlike many other fractures a buckle fracture is “stable” – thus making it an ideal candidate for a removable wrist support splint, rather than a plaster cast,” said Kimber, one of the study co-authors.

Over an eight-month period in 2015, 540 paediatric patients were diagnosed with forearm fractures in the ED – 124 of which were buckle-type fractures.  Of these 124 patients, 94 were placed in removable splints.

“Under usual circumstances, no further review is required under the new pathway. Patients simply use the splint for 3-4 weeks as advised, and then remove it,” Kimber said.

“During the healing process, the splint can be removed while the child bathes or showers.”

The study found that management of buckle fractures using the new pathway was safe, efficient and cost-saving.

Kimber said the removable splints were easier to manage at home, more appealing to patients and parents and were quicker to apply in the Emergency Department.

“The research project was a collaborative effort between the FMC Paediatric Emergency Department and the FMC Orthopaedic Department and shows that by working together across disciplines and work areas we can achieve outcomes that benefit everyone,” she said. 

“Under the new pathway we now have less need for X-rays and plaster casts; and reduced outpatient reviews. Today’s parents are very busy people, so knowing their child is getting the best possible treatment without having to disrupt school times and get time off work to make numerous trips to hospital is a fantastic outcome.”

This article was originally published in Southern Health News.

This is a Creative Commons story from The Lead South Australia, a news service providing stories about innovation in South Australia. Please feel free to use the story in any form of media. The story sources are linked in with the copy and all contacts are willing to talk further about the story.

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