Comparison of treatment of forearm fractures by pediatric emergency physicians versus orthopedic residents in a pediatric emergency department

Abstract

Purpose: Forearm fractures are frequently seen in emergency departments (EDs), with displaced fractures usually treated by closed reduction (CR), typically performed by orthopedic surgeons. However, pediatric emergency medicine physicians (PEMPs) are also trained to treat the fractures. Non- or minimally-displaced fractures that require casting or splinting are even more common. Limited data are available to evaluate the outcome of such procedures performed by PEMPs. Methods: We conducted a retrospective study on patients younger than 18 years with forearm fractures who underwent CRs in the ED from January 2017 through December 2021. The primary outcomes were successful CR and ED length of stay (EDLOS). The secondary outcomes were hospitalization and positive prognosis at follow-ups, defined as adequate fracture healing without the need for additional interventions. The positive prognosis was analyzed not only from the study population but also from patients with non- or minimally-displaced fractures who forwent CRs. The outcomes were compared between the patients undergoing CRs performed by orthopedic residents or PEMPs. Results: Of 120 patients who underwent CRs, successful CR was observed in 93.3% (112/120), with no difference between the 2 groups (orthopedic residents, 92.2% vs. PEMPs, 95.3%; P = 0.508). A mean EDLOS (minutes) was shorter in the PEMP group (orthopedic residents, 297.5 ± 58.2 vs. PEMPs, 228.9 ± 102.4; P < 0.001). The hospitalization and positive prognosis showed no differences between the groups. Of 559 patients with non- or minimally-displaced fractures, the positive prognosis showed no difference between the groups (orthopedic residents, 27.8% vs. PEMPs, 32.4%; P = 0.128). Conclusion: PEMPs can safely perform forearm fracture reductions by effectively selecting cases with a high likelihood of success. These cases may be managed without an orthopedic referral, leading to shorter EDLOS and enhanced patient satisfaction without compromising results.