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G29(P) The management of children diagnosed with an uncomplicated clavicle fracture: broad-arm sling and written self-care information versus broad-arm sling and hospital outpatient follow-up
  1. RA Crowder,
  2. AG Rowland,
  3. S Tan,
  4. M Handford,
  5. MJ Stuart
  1. Emergency Department, North Manchester General Hospital, The Pennine Acute Hospitals NHS Trust, Manchester, UK

Abstract

Background and objectives In July 2013 the Paediatric Emergency Department (ED) of a UK District General Hospital seeing approximately 30000 children per year aged under 16 years in the ED, began managing children diagnosed with an uncomplicated (no skin compromise and no clinical neuro-vascular deficit) clavicle fracture with a broad-arm sling and written self-care information, rather than a broad-arm sling and hospital-based fracture clinic follow-up. All other children continued to be referred to the fracture clinic. This study assessed the impact of this change in practice.

Methods A 15 month retrospective review of all children diagnosed with a clavicle fracture was conducted. Referrals to fracture clinic and the number of children re-attending the ED with complications related to the initial injury (for example pain or sling problem) were analysed. All children had a broad-arm sling applied.

Results 91 children were diagnosed with a clavicle fracture, 59 (median 5/month) pre-change in practice and 32 (median 7/month) post-change.

64 (70%) were referred to the fracture clinic, (52 (88%) pre-change in practice and 12 (38%) post-change). The remainder were discharged with written self-care information.

In the one month following initial attendance, 3 (5%) re-attended the ED pre-change in practice and 0 (0%) post-change.

Conclusions Children with an uncomplicated clavicle fracture can be appropriately managed with a broad-arm sling and written self-care information, rather than by hospital fracture clinic follow-up. This more efficiently uses healthcare resources, reduces re-attendances during the month following initial injury and reduces social inconvenience for children and families.

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