863 Management of Paediatric Forearm Fractures Presenting to the Whittington Hospital Emergency Department: An Audit of Current Practice

Abstract

Abstract Aim The most common site of fractures in children is the forearm. According to BOAST standards, early closed reduction by manipulation, avoiding the need for admission and general anaesthesia, is the treatment of choice for most forearm fractures. Further, management should include a documented assessment of neurovascular status and formal consent. Our aim was to audit management of forearm fractures in our emergency department against these standards. Method Patients presenting to our emergency department with isolated and neurovascularly intact forearm fractures were retrospectively identified from Nov 2021 to April 2022. Initial case management was assessed against BOAST standards and, where early manipulation in the emergency department was not performed, cases were reviewed by an orthopaedic consultant to determine if this could have occurred. Results 24 patients were identified. The mean age at time of injury was 10 years. 62.5% of patients underwent manipulation within the emergency department of which 47% (7/15) were unsuitable to continue non-operative treatment. 37.5% of patient did not undergo manipulation, of these 44.4% (4/9) were deemed as could have been suitable for manipulation. This led to 67% (16/24) of patients requiring a procedure under general anaesthesia. Neurovascular assessment was documented for 29% and formal consent for manipulation for 0% of patients. Conclusions There is scope for more forearm fractures to undergo early closed reduction by manipulation in our emergency department, potential avoiding intervention under general anaesthesia. Documentation of neurovascular assessment and formal consent requires significant improvement. A hospital protocol is currently being produced to help standardise care of such injuries.