$acute buckle fracture wrist$

Even physicians functioning exclusively under salaried models are typically required to shadow bill. Intuitively, OHIP coding represents a highly specific indication of patient interaction with a physician, given that nearly all Ontario physicians must submit billing codes to receive compensation. There are no data-quality studies regarding OHIP coding of fracture follow-up. 54 These percentages are likely higher for common injuries such as low-risk pediatric distal radius fractures. Reporting of National Ambulatory Care Reporting System data is mandatory for all Ontario emergency departments, with accuracy at the level of granularity required for this study reported at 88.8% and 93.5% for main problem and intervention coding, respectively. We also excluded patients with the following characteristics that would make determination of exposure or outcome status unreliable: no valid Ontario Health Insurance Plan (OHIP) number and admission to hospital for any reason during the 6-week observation period. These factors would preclude the ability to isolate care related to the fracture of interest. Patients were excluded if they had a discharge disposition other than “home,” if they did not reside in Ontario, if the fracture was manipulated or operated on within 6 weeks, if there were other fracture diagnoses within 6 months or if there were comorbidities necessitating increased fracture surveillance. It is rare to see a wrist fracture in a child who cannot yet walk, and such a fracture is concerning for nonaccidental injury, which has a remarkably different course of follow-up. 1 The lower age limit corresponds to the age at which children are reliably walking, a requisite to have a fall onto outstretched hands with enough force to cause a fracture. The upper age limit is the approximate age of skeletal maturity, which differs between sexes and after which low-risk-type fractures are no longer seen. We included all children aged 2–12 years for girls and 2–14 years for boys presenting to an Ontario emergency department with a closed fracture of the distal radius, identified in the National Ambulatory Care Reporting System database between Oct. 32, 39 – 53 The aim of this study was to examine how low-risk pediatric distal radius fractures are being managed in Ontario, and to determine whether different hospital and physician types are making different choices regarding care. 39 – 41 Application of best evidence is linked to hospital infrastructure and resources, physician education and training, and research affiliation, but these relations have not been well studied for these fractures. 38 We are unaware of any formal Canadian or American guidelines providing guidance on managing this fracture type.ĭespite the evidence, large numbers of referrals to orthopedic surgeons have persisted for this fracture type. One formal guideline advising on management of these injuries, Choosing Wisely UK, cites plaster casting and scheduled follow-up for distal radius buckle fractures in its list of treatments and procedures that are of little or no benefit to patients. 2 – 4, 11 – 37 Many hospitals have also developed their own internal guidelines pertaining to this injury. This simplified treatment is supported in multiple systematic reviews, randomized controlled trials, cohort studies and literature reviews. 5 – 15 Rather, these fractures can be treated more simply, with a single diagnostic radiograph, removable immobilization that is taken off at home and no physician follow-up, with equivalent outcomes. However, a large body of evidence accumulated over the last 2 decades has shown that this is unnecessary and results in increased costs and more complications. 4 Historically these fractures have been seen for follow-up in hospital fracture clinics exclusively by orthopedic surgeons. 2, 3 One very common subtype of these fractures, buckle fractures, are stable injuries in which pediatric bone deforms without completely breaking. 1 Many of these fractures are minimally displaced (initial angulation < 15° in the sagittal plane and < 5 mm translation on the frontal plane), are at low risk for complications and yield excellent clinical results. Canadian guidelines are required to improve care of these fractures and to reduce the substantial overutilization of physician resources we observed.ĭistal radius fractures are the most common pediatric orthopedic injury, with an estimated 10 000 fractures yearly in Ontario.

$acute buckle fracture wrist$

Interpretation: While small hospital emergency departments, pediatricians and pediatric emergency medicine specialists were most likely to manage low-risk distal radius fractures without follow-up, the majority of these fractures in Ontario were not managed according to the latest research evidence.

$acute buckle fracture wrist$

Acute buckle fracture wrist