Success Rates for Reduction of Pediatric Distal Radius and Ulna Fractures by ED Physicians

Abstract

Objective: To determine the success rates for reduction of pediatric distal radius and/or ulna fractures by emergency department (ED) physicians. Methods: We conducted a retrospective study of children <18 years of age who presented to a large, urban free standing children’s hospital between January 1, 2009 and December 31, 2010 with a fracture of the radius and/or ulna. Patients were excluded if they had an open fracture, were taken directly to the operating room without attempted ED manipulation, or had additional fractures besides isolated radius/ulna fractures. The primary endpoint was the proportion of successful reductions of closed forearm fractures in the ED, as defined by first orthopedic follow up visit. Results: All reductions were performed by Board certified/eligible Pediatric Emergency Medicine (PEM) physician or PEM fellow. There were a total of 15 different PEM faculty and 10 PEM fellows that were involved in the fracture reductions during the study period. There were 295 forearm fractures reduced in the ED during the study period. The mean age was 8.27 years (median 8 years; range 1 to 16) and males comprised 69.2% (n=204) of the study group. A total of 225 (76.3%) fractures were of the distal forearm and 70 involved the midshaft (23.7%). All but 67 (22.7%) patients returned for their orthopedic follow up exam. A total of 33 (14.5%) of all patients required re-manipulation at follow up; 24 in the distal forearm fracture group (22 were closed reductions and 2 open reduction with internal fixation [ORIF]), versus 9 in the midshaft group (7 closed reductions and 2 ORIF). Conclusion: The literature reveals that between 7% and 39% of children who have fracture reductions in the ED by orthopedics will require re-manipulation. Our rate of 14.5% is consistent within that range. With training, pediatric ED physicians have similar success rates as orthopedists in the reduction of forearm fractures.