The feasibility of closed reduction by emergency physicians with the aid of remote consultation in pediatric closed diaphyseal forearm fractures

Abstract

Objective: Still, conservative management is usually preferred for treating pediatric closed diaphyseal forearm fractures in the Emergency Department (ED). The aim of this study was to evaluate the feasibility of closed reduction by Emergency Medicine (EM) physicians with the aid of remote consultation by Orthopedic Surgeons (OS) in pediatric closed diaphyseal forearm fractures. Material and Methods: The study was conducted as a single-center, retrospective, observational study in 112 pediatric patients (age less than 14 years) with closed diaphyseal forearm fractures at a tertiary pediatric trauma center. Patients were either treated by EM physicians with remote consultation by OS or by OS. Door-to-reduction time was calculated as the time between the ED admission time and post-reduction plain radiograph recording time. Results: The mean age of 112 patients was 8.6 ± 3.0 years. 37 (33.0%) patients were treated by EM physicians and were discharged from ED. Orthopedic surgeons treated 75 (67.0%) patients. The angulation averages of post-reduction of all fractures were not statistically significantly different between emergency medicine physicians and orthopedic surgeons (p> 0.05). The average door-to-reduction time (minutes) (ADRT) for all fractures among the 8 years and the younger group was statistically significantly lower in the EM physicians (16.6*1.7) than in the OS (32.2*6.4) groups (MWU=527.5*0.001). The ADRT for all fractures in the older than 8 years group was significantly lower in the EM physicians (16.7±2.1) than in the OS (35.5±4.6) groups (MWU=406.0, p<0.001). Conclusion: EM physicians are able to perform an acceptable reduction with residual angulation degrees and fracture alignment of pediatric closed diaphyseal forearm fractures with the aid of remote consultation by OS.