Do toddler's fractures of the tibia require evaluation and management by an orthopaedic surgeon routinely?
Eur J Emerg Med
; 25(6): 423-428, 2018 Dec.
Article
en En
| MEDLINE
| ID: mdl-28628487
ABSTRACT
OBJECTIVE:
The majority of uncomplicated toddler fractures of the tibia (toddler's fractures) do not need an orthopaedic surgeon's intervention or follow-up. However, inexperienced emergency room physicians, general practitioners and orthopaedic trainees and surgeons understandably defer to a cautious approach of referral and subsequent frequent clinical and radiographic follow-up. An evidence-based pathway can help prevent this overtreatment, reduce unnecessary radiation exposure and decrease the financial burden on families and the healthcare system. PATIENTS ANDMETHODS:
A retrospective analysis of patients who presented for management of toddler's fractures to The Hospital for Sick Children (SickKids) was performed.RESULTS:
A total of 184 (113 boys, 72 girls) patients, of a mean age of 1.99 (range 0.2-3.9) years, were included for review. The included patients had attended 2.00±1.0 clinic visits and had had 5.86±2.7 radiographs taken on average. No complications such as cast injuries, nonunion, refracture or subsequent deformity needing assessment or intervention were identified.CONCLUSION:
Toddler's fractures do not require routine orthopaedic surgeon assessment, intervention or follow-up. If diagnosed and managed correctly at initial presentation, patients with toddler's fractures may be discharged safely without the need for further clinician contact. We developed a toddler's fracture clinical care pathway to reduce unnecessary orthopaedic surgeon referral and clinical and radiographic follow-up, thereby decreasing radiation exposure and costs to families and the healthcare system without risking patient outcomes.
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Fracturas de la Tibia
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Moldes Quirúrgicos
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Curación de Fractura
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Tratamiento Conservador
Tipo de estudio:
Diagnostic_studies
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Etiology_studies
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Guideline
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Incidence_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Límite:
Child, preschool
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Female
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Humans
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Male
País/Región como asunto:
America do norte
Idioma:
En
Año:
2018
Tipo del documento:
Article