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Management of paediatric elbow injuries, where is the equipoise? A UK and Ireland wide international survey of practice
  1. Patrick Aldridge1,
  2. Raj Rout2,
  3. Rachel Parish3,
  4. Damian Roland4,5,
  5. Daniel C Perry6,7,8,
  6. Mark D Lyttle9,10
  7. Paediatric Emergency Research in the United Kingdom & Ireland (PERUKI)
    1. 1Frimley Park Hospital NHS Foundation Trust, Frimley, UK
    2. 2Galderma UK Ltd, Watford, Hertfordshire, UK
    3. 3Frimley Health NHS Foundation Trust, Frimley, Surrey, UK
    4. 4Health Sciences, University of Leicester, Leicester, UK
    5. 5Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, University Hospitals of Leicester NHS Trust, Leicester, UK
    6. 6University of Liverpool Faculty of Health and Life Sciences, Liverpool, UK
    7. 7Alder Hey Children's NHS Foundation Trust, Liverpool, Merseyside, UK
    8. 8Oxford Trauma and Emergency Care, Kadoorie Research Centre, Nuffield Department of Orthopaedic, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
    9. 9Emergency Department, Bristol Royal Hospital for Children, Bristol, UK
    10. 10Academic Department of Emergency Care, University of the West of England, Bristol, Avon, UK
    1. Correspondence to Dr Patrick Aldridge; patrickjaldridge{at}hotmail.com

    https://doi.org/10.1136/archdischild-2024-327051

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      Elbow fractures are the second most common childhood fracture typically classified using the Wilkins-modified Gartland classification system. Limited national guidance exists across the UK and Ireland for their management. We aimed to ascertain variation in management, to determine whether future research is required to improve supracondylar injury care.

      Following piloting and refinement, all 76 Paediatric Emergency Research in the United Kingdom & Ireland (PERUKI) sites were invited to participate and those who agreed had an online REDCap survey distributed 24 May 2023–27 June 2023 to nominated consultants. Respondents answered on behalf of their departmental colleagues, with collaborative local Orthopaedic input. The survey contained questions (multiple selection and free-text answer) on progressively severe elbow injury radiographs (normal to Gartland 3, anteroposterior and lateral) regarding emergency department (ED) management, surgical intervention, treatment duration and follow-up (online supplemental appendix A). Images (online supplemental appendix B) were sourced from Radiopaedia.org and boneschool.com. To mitigate misinterpretation, a description of findings was included alongside each image (box 1). No mechanism of injury or physical findings were described.

      Supplemental material

      [archdischild-2024-327051supp001.pdf]

      Supplemental material

      [archdischild-2024-327051supp002.pdf]

      Box 1

      Description of radiographs shared with participants.

      • Normal image—‘an anterior fat pad parallel to the anterior humerus and no posterior fat pad’.

      • Gartland 1—‘a posterior fat pad with a small anterior distal humerus cortical break and no displacement’.

      • Gartland 2A with minor sagittal displacement and no coronal displacement—‘…complete cortical disruption with minor angulation of the distal humerus, displacement of the capitellum and no coronal displacement. Anterior humeral line abuts anterior aspect of capitellum’.

      • Gartland …

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      Footnotes

      • X @damian_roland, @mdlyttle

      • Collaborators Sue Deakin (West Suffolk Hospital), Rachel Shute (West Suffolk Hospital), Kirsty Challen (Royal Preston Hospital), Antonia Hoyle (Royal Preston Hospital), Joanne Mulligan (University Hospital Crosshouse), Manish Thakker (Royal Berkshire NHS Foundation Trust), Neville Davies(Royal Berkshire NHS Foundation Trust), Sharryn Gardner (Ormskirk & District General Hospital), Chevelle Cafadaru (Whittington Health NHS Trust), Erum Jamall (Whittington Health NHS Trust), Orla Callender (Children's Health Ireland at Temple Street), Sylvester Gomes (Evelina London Children's Hospital), Luke Harries (Great Western Hospital, Swindon), Phil Peacock (Great Western Hospital, Swindon), Gareth Patton (Royal Aberdeen Children's Hospital), Mike Reidy (Royal Aberdeen Children's Hospital), Edward Snelson (Norfolk & Norwich University Hospitals), Amutha Anpananthar (Whipps Cross Hospital, London), Nick Aresti (Whipps Cross Hospital, London), Gail Ng (Salisbury NHS Foundation Trust), Bob Basu (Bradford Royal Infirmary), Sheena Durnin (Children's Health Ireland at Tallaght), Peter Domos (Barnet Hospital), Rob Stellman (Barnet Hospital), Fleur Cantle (King's College Hospital, London), Piers Mitchell (Peterborough City Hospital), Fiona Maxton (Peterborough City Hospital), Atif Latif (Kingston Hospital NHS Foundation Trust), Simon Richardson (Hull Royal Infirmary), Nicole Corin (Royal United Hospital, Bath), Emma Long (Royal United Hospital, Bath), Hani Abdul-Jabar (Northwick Park Hospital), Michelle Jacobs (Northwick Park Hospital), Emma Jenkinson (Royal Wolverhampton NHS Trust), Emre Basatemur (The Royal London Hospital), Charles Stewart (Chelsea and Westminster NHS Foundation Trust), James Ross (Chelsea and Westminster NHS Foundation Trust), Jordan Evans (University Hospital of Wales, Cardiff), Clare Carpenter (University Hospital of Wales, Cardiff), Niall Mullen (South Tyneside & Sunderland NHS Foundation Trust), Ling Lee (South Tyneside & Sunderland NHS Foundation Trust), David Hartin (Ipswich Hospital), Sarah Wilson (Wexham Park Hospital), Caroline Ponmani (Barking, Havering & Redbridge University Hospitals NHS Trust), Clare O'Leary (St Helen's & Knowsley NHS Trust), Jen Browning (Royal Hospital for Children & Young People, Edinburgh), Thomas Waterfield (Royal Belfast Hospital for Sick Children), Alice Downes (Leeds General Infirmary), Charlotte Brown (John Radcliffe Hospital, Oxford), Gisela Robinson (Royal Derby Hospital), Miki Lazner (Royal Alexandra Children's Hospital, Brighton), Alexandra Taylor (Bristol Royal Hospital for Children), James Singleton (Frimley Park Hospital), Michael Barrett (Children's Health Ireland at Crumlin), Sophie Keers (University Hospital Lewisham), Steve Foster (Royal Hospital for Children, Glasgow), Richard Freeman (Northumbria Healthcare NHS Foundation Trust), David James (Southampton Children's Hospital), Ronan O'Sullivan (Bon Secours Hospital, Cork).

      • Contributors PA is overall guarantor and along with ML contributed to study conception and design, data collection, data analysis/interpretation and manuscript preparation. RR contributed to study conception and design, data analysis/interpretation and manuscript preparation. RP contributed to study conception and manuscript preparation. DP and DR contributed to study design and manuscript preparation.

      • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

      • Competing interests None declared.

      • Provenance and peer review Not commissioned; externally peer-reviewed.

      • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.