Current diagnosis and management of toddler's fracture

Pelayo, Sandra Llorente; Fernández, Juan Rodríguez; Cabello, M. Teresa Leonardo; Lorenzo, Mónica Rubio; Alfaro, M. Dolores García; Jiménez, Carmelo Arbona

doi:10.1016/j.anpede.2019.06.010

Cited by 2 publications

(2 citation statements)

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“…They also noted no difference in outcomes between those casted versus those not immobilized, with no complications seen in the nonimmobilized group. Pelayo et al 12 additionally reported a higher complication rate in patients who were immobilized in a cast or splint (21.4%), with the majority of these complications involving skin injuries (19%). Again, there were no skin complications in the nonimmobilized group with no significant differences in time to weight-bearing.…”

Section: Discussionmentioning

confidence: 99%

“…Management of toddler's fractures has evolved over the last several decades with continued variation in treatment options, ranging on one end from rigid long leg cast immobilization with repeat visits to remove the cast and re-image the leg to treatment with a removable boot without any repeat clinical or radiographic follow-up, to no immobilization at all. [4][5][6][7][8][9][10]12 A 2018 survey of the Pediatric Emergency Research Canada network 13 highlighted significant nationwide practice variation in the management of both confirmed and presumed toddler's fractures, ranging from no immobilization to splinting, short leg casts, and long leg casts. Although numerous studies and systematic reviews support the notion that toddler's fractures are inherently stable with an excellent prognosis, the ideal treatment option is still left up to the provider's preference.…”

Section: Discussionmentioning

confidence: 99%

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Reducing Rigid Immobilization for Toddler’s Fractures: A Quality Improvement Initiative

Chen,

Holstine,

Samora

2024

Pediatric Quality &Amp; Safety

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Background: Toddler’s fractures are one of the most common orthopedic injuries in young walking-age children. They are defined as nondisplaced spiral-type metaphyseal fractures involving only the tibia without any injury to the fibula and are inherently stable. We aimed to use quality improvement methodology to increase the proportion of patients with toddler’s fractures treated without cast immobilization at a large tertiary referral pediatric orthopedic center from a baseline of 45.6%–75%. Methods: Baseline data on patient volume and treatment regimens for toddler’s fractures were collected starting in February 2019. Monthly data were collected from the electronic medical record and reviewed to determine treatment (cast versus noncast immobilization) and tracked using statistical process control charts (p-chart). After determining the root causes of treatment using immobilization, interventions tested and adopted included physician alignment of expectations for treatment, sharing unblinded compliance data with providers, updating patient education materials, and updating resident education and reference materials. Results: After interventions were in place, the percentage of patients treated without CAST immobilization increased from 45.6% to 90% (P ≤ 0.001). We also observed improvement in our process measure to increase the percentage of this population receiving boot immobilization during new patient visits in our orthopedic clinics (4.15% to 52%, P ≤ 0.001). Conclusions: By aligning provider and family expectations for treatment, demonstrating no clinical need for cast immobilization, and bringing awareness of compliance to appropriate guidelines, our institution was able to improve care for patients with toddler’s fractures and reduce financial and care burdens for families.

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Section: Discussionmentioning

confidence: 99%