Original Research Management of Distal Radial Fractures in Young Patients by Non-Orthopedists in an Urgent Care Center Urgent message: Distal radial fractures in children can often be treated by non-orthopedists without the need for full casting in an urgent care center that can perform simple splinting, thus sparing hospital referral. Deena R. Zimmerman, MD, MPH, IBCLC, Scott Fields, MD, and Nahum Kovalski, BSc, MDCM Introduction rist fracture is a com- mon injury in chil- dren. 1 Many of these fractures are buckle or torus fractures. Tradi- tionally, treatment for buckle fractures has been short-arm casting for two to four weeks. 2 However, questions have been raised as to the need for such treatment. A num- ber of recent studies have indicated that many such fractures may be managed without casting by the use of either elastic bandaging alone 3 or splints. 4-6 Plaster splints can easily be applied in an urgent care framework, thus sparing the family the need for hospital referral. For appropriate care to be delivered in an urgent care setting, it is important not only that the treatment is cor- rect, but that the diagnosis is, as well. Clinical evaluation w w w. j u c m . c o m © Getty.com/Richard Price W alone of the injured wrist is likely to miss 20% of fractures and overcall 37%, which indi- cates that x-ray evaluation is clinically important in wrist fracture care. 7 The utility of an x-ray eval- uation, however, assumes that the initial x-ray assessment to identify the presence and sever- ity of the fracture is accurate even without on-site review by a radiologist or orthopedist. In light of the above, we decided to study our experience in TEREM Emergency Medical Centers in relation to the accu- racy of interpretation of wrist x-ray findings in children. Materials and Methods Setting TEREM Emergency Medical Centers is a privately owned medical services company based in Jerusalem, Israel JUCM T h e J o u r n a l o f U r g e n t C a r e M e d i c i n e | J u l y/A u g u s t 2 0 0 7 19