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
Wrist fracture is a com-mon injury in children. Many of these fractures are buckle or torus fractures. Traditionally, treatment for buckle fractures has been short-arm casting for two to four weeks.
However, questions have been raised as to the need for such treatment. A number of recent studies have indicated that many such fractures may be managed without casting by the use of either elastic bandaging alone or splints. 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 correct, but that the diagnosis is, as well. Clinical evaluation alone of the injured wrist is likely to miss 20% of fractures and overcall 37%, which indicates that x-ray evaluation is clinically important in wrist fracture care.
The utility of an x-ray evaluation, however, assumes that the initial x-ray assessment to identify the presence and severity 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 accuracy of interpretation of wrist x-ray findings in children.