Article Text
Abstract
Background and aims Children presenting to Paediatric Emergency Department (PED) with suspected clavicular fractures undergo radiographs to confirm the diagnosis and are referred to fracture clinic. Subsequent management depends on the site and displacement of fracture and presence of complications. However young children have excellent remodelling potential and the majority are managed conservatively.
The primary aim was to survey fracture clinic interventions of clavicular fractures in children under 7. The secondary aim was to assess the cost effectiveness of referrals to fracture clinic from PED.
Methods Patients were identified through a retrospective review of radiographs positive for clavicular fractures between 21/10/12 and 21/10/13 in children under 7. Information on fracture clinic interventions was obtained by examination of patient records.
Results 40 children were identified and 35 included (records unavailable for 5 children). The majority of fractures were in the middle third of the shaft; 13 were undisplaced (Figure 1). 31 children were referred to fracture clinic, 2 declined and 2 were not referred. None of the 31 children received additional treatment although 15 had a follow-up appointment and a further 2 had a second follow-up appointment (Figure 2).
The cost of fracture clinic referrals was £9,141.25, further costs including parental absence from work were not possible to estimate. The benefit of added reassurance for the parent is uncertain.
Conclusions The management of clavicular fractures irrespective of site or displacement in children under 7 in one cohort of patient was uniformly conservative, hence referral to the fracture clinic may not be necessary.
Fracture clinic may not be necessary
Management in fracture clinic