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One Visit-one Brace: Patient and Parent Satisfaction After Treatment for Pediatric Distal Radius Buckle Fractures

Kuba, Megan HM MD; Izuka, Byron H. MD; Freese, Krister P. MD

Journal of Pediatric Orthopaedics: March 2017 - Volume 37 - Issue 2 - p 157
doi: 10.1097/01.bpo.0000513120.75101.22
American Academy of Pediatrics Orthopaedics 2016 Abstracts: 2016 Young Investigator Awards

*University of Hawaii, Honolulu, HI

University of Hawaii, Aiea, HI

Denver Children’s Hospital, Aurora, CO

Purpose: Multiple previously published studies have shown the efficacy of brace treatment for distal radius buckle fractures. There is also literature to support the fact that these inherently stable injuries do not require additional radiographic imaging. However, no study has looked at a treatment protocol combining both of these aspects. We aim to determine if the treatment of pediatric buckle fractures of the distal radius, with a removable brace and no further physician follow-up or imaging after the initial visit, is a safe and satisfactory therapeutic protocol.

Methods: 42 consecutive patients with a diagnosis of distal forearm buckle fracture seen by a single practicing pediatric orthopaedic surgeon were recruited to participate in this IRB approved study. 2 patients refused participation, leaving 40 patients treated with a standard protocol as follows: immobilization with a removable wrist brace, worn for a prescribed time period; no additional imaging or clinical follow-up. Two telephone surveys were administered to each of the 40 patients. The first call was made within 1 week of the designated brace-removal date to determine the exact date the brace was discontinued. The second call was made 5-10 months post-injury to determine patient outcomes and parent satisfaction after the treatment via a series of 17 questions.

Results: 100% of patients were reached for the initial phone call. 36/40 patients (90%) were available to answer the second phone survey questionnaire. There were no complications, including re-fracture or residual pain, following the treatment. Only 4/36 (11%) required any type of pain medication, and all took only over-the-counter ibuprofen or acetaminophen. No patients required narcotics for pain control. 100% of parents said they would choose to have the same treatment again, as 68% would have had to miss work and 78% would have had to pull the child out of school if they had been required to attend a follow-up appointment.

Conclusion: Treatment of distal forearm buckle fractures with a removable brace and no follow-up visit results in both good patient outcomes and parental satisfaction. This treatment method is both directly and indirectly cost-effective, prevents additional radiation exposure, and increases access to care as it leaves additional appointments available in the busy pediatric orthopaedic practice.

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