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Evidence Into Practice: Emergency Physician Management of Common Pediatric Fractures

Boutis, Kathy MD*; Howard, Andrew MD; Constantine, Erika MD; Cuomo, Anna MD§; Narayanan, Unni MD

doi: 10.1097/PEC.0000000000000162
Original Articles

Objectives Randomized trials have shown that removable immobilization devices are at least as good as circumferential casts for the management of common specific types of pediatric wrist and ankle fractures. Our main objective was to determine the proportion of emergency physicians who prescribe removable devices for distal radius buckle fractures and/or nondisplaced distal fibular Salter-Harris I fractures. We also examined follow-up referral patterns for these injuries.

Methods This was an online survey of members of 2 national emergency physician associations in Canada: Pediatric Emergency Research Canada and the Canadian Association of Emergency Physicians.

Results Of the 849 eligible participants, 447 responded to the survey, yielding an aggregate response rate of 52.7%. Organization-specific response rates were 169 (70.4%) of 240 for the Pediatric Emergency Research Canada and 278 (45.6%) of 609 for the Canadian Association of Emergency Physicians. Overall, 263 of 416 (63.2%; 95% confidence interval [CI], 58.6–67.8) of emergency physicians treat buckle fractures of the distal radius with a removable splint and refer 212 of 398 (53.3%; 95% CI, 48.4–58.2) of these injuries to the primary care physician for follow-up. For Salter-Harris I fractures of the distal fibula, emergency physicians treat 201 of 416 (48.3%; 95% CI, 43.5–53.1) with a removable ankle support and refer 94 of 398 (23.6%; 95% CI, 19.4–27.8) to the primary care physician for follow-up.

Conclusions At least 50% of the surveyed Canadian emergency physicians treat distal radius buckle fractures and/or Salter-Harris I fibular fractures with a removable immobilization device, and the primary care physician follow-up of these injuries occur with some regularity for both these injuries.

From the *Division of Emergency Medicine, Department of Pediatrics, and †Division of Orthopedic Surgery, the Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; ‡Departments of Emergency Medicine and Pediatrics, Section of Pediatric Emergency Medicine, Alpert Medical School of Brown University, Rhode Island Hospital/Hasbro Children’s Hospital, Providence, RI; and §Department of Orthopedic Surgery, Shriners Hospital for Children (Los Angeles), University of California Los Angeles, Los Angeles, CA.

Disclosure: The authors declare no conflict of interest.

Reprints: Kathy Boutis, MD, 555 University Ave, Toronto, Ontario, Canada, M5G 1X8 (e-mail:

© 2014 Lippincott Williams & Wilkins, Inc.