Resident Versus Attending Surgeons in Achieving and Maintaining Fracture Reduction in Pediatric Distal Radius Fractures.

Abstract

Distal third forearm fractures are one of the most common orthopaedic injuries in the pediatric population with a reported risk of redisplacement in the range of up to a third following initial reduction. The aims of this study were to determine whether fracture redisplacement and adequacy of cast molding were associated with surgeon seniority in the treatment of displaced pediatric distal third radius fractures that required manipulation under anesthesia. This study prospectively randomized 143 pediatric patients presenting to a tertiary referral hospital with a fractured distal radius into 2 groups. We compared the surgeon seniority (resident vs. attending surgeon) with the cast index (CI) and amount of displacement/angulation postreduction. Our results showed no significant difference in CI according to level of experience between resident and attending surgeon (P=0.14). There was also no difference in redisplacement for fracture types relative to seniority. Median redisplacement for resident and attending, respectively, for type Arbeitsgemeinschaft für Osteosynthesefragen (AO) 23E was 6% (range, 0% to 42%) versus 6% (range, 0% to 41%) P=0.98. For type AO 23M reangulation was 4 degrees (range, 0 to 29 degrees) versus 5 degrees (range, 0 to 18 degrees) P=0.97, respectively. Our results indicate that the level of seniority does not influence the CI or redisplacement/angulation of fractures after closed reduction. Residents appear well trained in cast application. Level I-randomized-controlled trial.