Closed Reduction of Distal Forearm Fractures by Pediatric Emergency Medicine Physicians: A Prospective Study

NCT ID: NCT01101607

Last Updated: 2010-04-12

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

104 participants

Study Classification

INTERVENTIONAL

Study Start Date

2008-04-30

Study Completion Date

2010-04-30

Brief Summary

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Distal forearm fractures are amongst the most frequently encountered orthopedic injuries in the pediatric emergency department (ED). Immediate closed manipulation and cast immobilization, is still the mainstay of management. The initial management of non-displaced or minimally displaced extremity fractures and relocation of uncomplicated joint dislocations is part of the usual practice of emergency medicine. Although focused training in fracture-dislocation reduction techniques is a part of the core curriculum of emergency medicine training programs, there is limited data discussing outcomes following restorative fracture care by pediatric emergency medicine (PEM)physicians.

The primary objective of this study is to compare length-of-stay and clinical outcomes after closed manipulation of uncomplicated, isolated, distal forearm fractures, by PEMs to those after manipulation by pediatric orthopedic surgeons. Our hypothesis is that there is no difference in emergency department length-of-stay when fracture reduction is performed by a PEM versus a post graduate year 3 or 4 orthopedic resident. Secondary outcomes that will be assessed include: loss of reduction needing re-manipulation at follow up, cast related complications, radiographic and functional healing at 6-8 weeks post injury.

Detailed Description

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Pediatric forearm fractures are common injuries and a frequent cause for an emergency room admission. Ward et al have outlined the demands that emergency department coverage places on practicing orthopedic surgeons. Assuming no statistically significant differences in outcomes, there are potential advantages of having PEMs provide restorative fracture care at the initial visit. This practice would permit judicious orthopedic consultation at a time when several emergency department's are facing an "on call" specialist coverage crisis and there exists a nationwide shortage of fellowship trained pediatric orthopedic specialists, in addition to ACGME mandated duty hour restrictions for orthopedic residents.

Pershad et al conducted a retrospective study with historical controls, of 60 patients with distal radius fracture that were reduced by an orthopedic resident or PEM physician. In this review, there were no differences in rates of re-intervention to restore fracture alignment or ED length-of-stay between the two groups.Mean facility charges were lower in the group treated by PEMs.

It is our hypothesis that with goal directed training, PEM physicians can perform closed reduction of uncomplicated distal forearm fractures with outcomes that are similar to when fracture reduction is performed by senior orthopedic resident physicians.

Conditions

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Pediatric Distal Forearm Fractures

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

HEALTH_SERVICES_RESEARCH

Blinding Strategy

SINGLE

Investigators

Study Groups

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Pediatric Emergency Physician

Patients randomized to Pediatric Emergency Physician Group will have their fracture reduced by a Pediatric Emergency Physician

Group Type ACTIVE_COMPARATOR

Distal Forearm Fracture Reduction

Intervention Type PROCEDURE

Fracture reduction

Orthopaedic physician

Patients to be randomized to Orthopaedic physician Group will have their fracture reduced by an Orthopaedic Physician

Group Type ACTIVE_COMPARATOR

Distal Forearm Fracture Reduction

Intervention Type PROCEDURE

Fracture reduction

Interventions

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Distal Forearm Fracture Reduction

Fracture reduction

Intervention Type PROCEDURE

Eligibility Criteria

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Exclusion Criteria

\-
Minimum Eligible Age

6 Months

Maximum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University of Tennessee

OTHER

Sponsor Role collaborator

Le Bonheur Children's Hospital

OTHER

Sponsor Role collaborator

Campbell Clinic

OTHER

Sponsor Role collaborator

InMotion Orthopaedic Research Center

OTHER

Sponsor Role lead

Responsible Party

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InMotion Orthopaedic Research Center

Principal Investigators

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Jay Pershad, MD

Role: STUDY_DIRECTOR

University of Tennessee Health Sciences

Shehma Khan, MD

Role: PRINCIPAL_INVESTIGATOR

University of Tennessee Health Sciences

Locations

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Lebonheur Medical Center

Memphis, Tennessee, United States

Site Status

Countries

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United States

References

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Ward WT, Eberson CP, Otis SA, Wallace CD, Wellisch M, Warman JR, Leitch KK, Epps HR, Richards BS. Pediatric orthopaedic practice management: the role of midlevel providers. J Pediatr Orthop. 2008 Dec;28(8):795-8. doi: 10.1097/BPO.0b013e318183249f. No abstract available.

Reference Type BACKGROUND
PMID: 19034167 (View on PubMed)

Ward WT, Rihn JA. Demographic and financial implications of pediatric emergency department fracture manipulation. J Pediatr Orthop. 2007 Dec;27(8):877-81. doi: 10.1097/BPO.0b013e3181558c4d.

Reference Type BACKGROUND
PMID: 18209607 (View on PubMed)

Pershad J, Williams S, Wan J, Sawyer JR. Pediatric distal radial fractures treated by emergency physicians. J Emerg Med. 2009 Oct;37(3):341-4. doi: 10.1016/j.jemermed.2008.08.030. Epub 2009 Feb 6.

Reference Type BACKGROUND
PMID: 19201136 (View on PubMed)

Other Identifiers

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MHIRB 2008-006

Identifier Type: -

Identifier Source: org_study_id

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