Article Text

Putting evidence based protocols into practice- a paediatric buckle fracture pathway
  1. RJ Rowlands1,
  2. G Geelhoed1,
  3. K Stannage2
  1. 1Paediatric Emergency Department, Princess Margaret Hospital, Perth, Australia
  2. 2Paediatric Orthopaedic Department, Princess Margaret Hospital, Perth, Australia


Background and aims Distal forearm fractures are a common injury of childhood. They are traditionally treated in a plaster of Paris back slab (POP) and referred for orthopaedic follow up. Evidence shows these fractures may be treated in removable splints without follow up.

A pathway for splinting such fractures with removable fabric and metal splints was introduced in our department. Aims were to reduce return trips to hospital for follow up decreasing disruption to families, free up medical and nursing time and ultimately produce an economic benefit to the hospital.

Methods A control group of patients treated in a POP was identified. Detailed notes review showed those eligible for a removable splint, number of x-rays performed and follow up visits. The average time taken to apply a POP was determined. A previously implemented pathway and information leaflet were modified for local use and staff educated about the change. A “safety net” of x-ray review by a consultant Orthopaedic surgeon was put in place for all patients placed in a removable splint.

Study data was captured from the Electronic Emergency Department Information System (EDIS) (figure 1).

Abstract G290 Figure 1


Results Over 15 weeks there were 348 forearm fractures of which 37% were buckle fractures. No child placed in a removable splint required a change in treatment plan after orthopaedic “safety net” review (figure 2).

Abstract G290 Figure 2

Flow diagram of forearm fractures.

There was a statistically significant reduction in the time from doctor review until discharge of approximately 20 minutes (p<0.001). There has been a reduction of 50% in the number of x-rays and decrease from 4 to 1 in the median number of hospital visits (figure 3).

Abstract G290 Figure 3

Graph of x-rays and OPA attendances.

The changes equate to a money and time cost saving for the family and hospital that is yet to be fully quantified. In our department the change would equate to a reduction of 600 patients or 1800 attendances per year in fracture clinic.

Conclusions This pathway shows how a simple evidence based pathway can improve the patient journey, reduce healthcare expenditure and release time to care.

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