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· DOS Abstracts
Closed reduction and casting of paediatric forearm
fractures in Denmark - a lost art?
Jens Brahe Pedersen, Martin Gottliebsen
Ortopædkirurgisk Afdeling E, Traumesektionen, Aarhus Universitetshospital
Background:
Children have great potential for fracture remodeling. A large
proportion of pediatric forearm fractures can be treated safely with closed re-
duction and casting. A cast index (CI) above 0.8 can be used as a predictor for
loss of reduction. Studies have shown that these injuries are increasingly being
managed with surgery and internal fixation. This trend does not appear to be
backed by clinical research. We conducted a survey on training and knowledge
of closed treatment techniques amongst specialist orthopaedic surgeons and
trainees in Denmark.
Purpose / Aim of Study:
Our aim was to investigate if the level of knowledge
and training of closed reduction and casting techniques was associated to doc-
tors’ preferred treatment of paediatric forearm fractures.
Materials and Methods:
An electronic questionnaire was distributed to re-
sponders through all orthopaedic departments in Denmark and the Facebook
page of YODA (forum for orthopedic trainees in Denmark).
Findings / Results:
236 doctors completed the survey. 152 (65%) favored
surgical treatment. Only 59 (25%) were able to correctly identify CI as a pre-
dictor for loss of fracture reduction. Doctors who lacked knowledge of closed
treatment techniques were significantly more likely to prefer surgical treatment
and significantly less likely to apply casts independently.
Conclusions:
Closed reduction and casting of paediatric forearm fractures is
a safe, noninvasive technique with good results if performed properly. Surgi-
cal treatment is preferred by a majority of responders but our survey indicates
that lack of experience with closed techniques affects treatment preference.
We recommend that casting techniques become a formal part of the curriculum
for Danish orthopaedic trainees.
No conflicts of interest reported
162.