Distal Radius Buckle Fracture Follow up Study
Condition: Distal Radius Fracture
MeSH terms: Fractures, Bone; Radius Fractures; Wrist Fractures
Study type: Interventional

Summary: 
      The investigators will be enrolling children with distal radius buckle fractures, treating
      them with a removable splint and randomizing them to follow up as needed vs required follow
      up with a primary care physician 1-2 weeks after the ED visit.
    

Detailed description: 
      Buckle fractures of the distal forearm that include the radius are the most common fracture
      in childhood, and the risk of this fracture occurring is about 1 in every 25 children.Despite
      the high frequency of this fracture, it is a very stable injury and thus can be safely
      treated with a removable wrist splint while the fracture heals. Furthermore, authors have
      concluded that since orthopedic intervention is exceedingly rare, this type of fracture may
      safely be followed by a primary care physician (PCP) or managed at home.

      In Canada, about 50% of these injuries are routinely discharged from the ED for follow up
      with the PCP, instead of an orthopedic clinic. The investigators' work examined the
      management outcomes of 180 children with a distal radius buckle fractures who were treated in
      an ED with a removable splint, given anticipatory guidance, and advised to follow up in two
      weeks with their PCP. We demonstrated that PCP follow up was safe and effective, with about
      90% of patients completing their care at the PCP without additional visits to an ED or
      orthopedic surgeon. All patients recovered as expected without complications. However, about
      50% of these patients did not receive additional anticipatory guidance from their PCPs on
      duration of splint use or expected timing of return to usual activities at the PCP visit.
      Nevertheless, patients with and without this additional anticipatory guidance reported a
      similar duration of splint use and timing for return to usual activities, largely based on
      what was recommended at the ED visit. Since these injuries are inherently stable, carry an
      excellent prognosis, and are treated with a splint that can be removed at home in accordance
      with anticipatory guidance provided in the ED, it calls into question the need for any
      routine physician follow up of these common minor fractures.

      If home management of distal radius buckle fracture after ED discharge demonstrated safety
      and effectiveness in a methodologically robust study, it would have clear advantages for
      patients and families, physicians, and the health care system. The frustrations of lengthy
      clinic visits and transport difficulties would be avoided. Parents would miss less time away
      from work or other priorities, and the patients themselves would not miss school. In
      medically under-serviced communities in particular, patients would avoid long travel
      distances to see a physician for this minor injury where physician intervention after the ED
      visit is rarely required. Furthermore, it will obviate the need to shift the care of these
      common minor fractures from the orthopedic surgeon to the PCP, relieving some pressure on
      health care practitioners and increase availability for other patients more in need of
      physician services. Importantly, the potential for reduced use of superfluous health care
      services for this common injury is also likely to result in health care cost savings.
    

Intervention name(s): Follow up
Intervention type(s): Other
Intervention description(s): The intervention will be method of follow up.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Enrolled patients will be randomized to one of two follow up arms
Masking: Single (Outcomes Assessor)
Primary purpose: Health Services Research