The Archives of Bone and Joint Surgery

The Archives of Bone and Joint Surgery

How Much are Emergency Medicine Specialists’ Decisions Reliable in the Diagnosis and Treatment of Pediatric Fractures?

Document Type : RESEARCH PAPER

Authors
Mohsen Mardani-Kivi
Behzad Zohrevandi
Khashayar Saheb-Ekhtiari
Keyvan Hashemi-Motlagh
Guilan Road Trauma Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
10.22038/abjs.2016.4583
Abstract
 
Background: Considering the importance of an early diagnosis and proper decision-making in regards to the treatment of pediatric distal radius and elbow fractures, this study examines emergency medicine specialists’ accuracy in the diagnosis and treatment of these patients.

Methods: From 2012 and 2013, children less than 14 years old who were referred to an academic hospital emergency department with elbow or distal radius fractures were enrolled. Initially, patients were examined by an emergency medicine specialist and then they were referred to an orthopedic surgeon. Type of fracture and the proposed treatment of two specialists were compared.

Results: In total, there were 108 patients (54 patients in each group) with a mean age of 8.1+3.3 years. Identical diagnosis in 48 cases (88.9%) of distal radius and 36 cases (66.7%) of elbow trauma were observed. We found a difference between diagnosis of the two specialists in diagnosing lateral condyle of the humerus fracture in the elbow group and growth plate fracture in the distal radius fracture group, but the differences were not significant. Among 108 patients, 70 patients (64.8%) received identical treatment.

Conclusion: Although the emergency medicine specialists responded similarly to the orthopedic specialists in the diagnosis of pediatric distal radius and elbow fractures, diagnosis of more complicated fractures such as lateral condylar humoral fractures, distal radius growth plate and for choosing the proper treatment option, merits further education.
Keywords
Distal radius fracture
Emergency Medicine
Elbow fracture
Orthopedics
Pediatrics

  1. References

    1. Park MS, Chung CY, Choi IH, Kim TW, Sung KH, Lee SY, et al. Incidence patterns of pediatric and adolescent orthopaedic fractures according to age groups and seasons in South Korea: a population-based study. Clin Orthop Surg. 2013; 5(3):161-6.
    2. Randsborg PH, Gulbrandsen P, Saltyte Benth J, Sivertsen EA, Hammer OL, Fuglesang HF, et al. Fractures in children: epidemiology and activity-specific fracture rates. J Bone Joint Surg Am. 2013; 95(7):e42.
    3. Rennie L, Court-Brown CM, Mok JY, Beattie TF. The epidemiology of fractures in children. Injury. 2007; 38(8):913-22.
    4. Mounts J, Clingenpeel J, McGuire E, Byers E, Kireeva Y. Most frequently missed fractures in the emergency department. Clin Pediatr (Phila). 2011; 50(3):183-6.
    5. Kachalia A, Gandhi TK, Puopolo AL, Yoon C, Thomas EJ, Griffey R, et al. Missed and delayed diagnoses in the emergency department: a study of closed malpractice claims from 4 liability insurers. Ann Emerg Med. 2007; 49(2):196-205.
    6. Hallas P, Ellingsen T. Errors in fracture diagnoses in the emergency department--characteristics of patients and diurnal variation. BMC Emerg Med. 2006; 6(1):4.
    7. Zomorrodi A, Bennett JE, Attia MW, Loiselle J, Rogers KJ, Kruse R. Consistency between emergency department and orthopedic physicians in the diagnosis and treatment of distal fibular Salter Harris I fractures. Pediatr Emerg Care. 2011; 27(4):301-3.
    8. Shrader MW, Campbell MD, Jacofsky DJ. Accuracy of emergency room physicians’ interpretation of elbow fractures in children. Orthopedics. 2008; 31(12):34.
    9. World medical association declaration of Helsinki. Ethical Principles for Medical Research Involving Human Subjects. Amended by 59th WMA General Assembly (Seoul): World Medical Association; 2008; Available from: http://www.wma.net/en/30publications/10policies/b3/.
    10. Heidari K, Hatamabadi HR, Sabzghabaei A, Manouchehrifar M, Hanani K, Ahmadzadeh M, et al. The Efficacy of Closed Reduction of Distal Radius Fractures in Emergency Department. J Bas Appl Sci Res. 2013; 3(8):151-8.
    11. Pershad J, Williams S, Wan J, Sawyer JR. Pediatric distal radial fractures treated by emergency physicians. J Emerg Med. 2009; 37(3):341-4.
    12. Erthan ER, Kara PH, Oyar O, Unluer EE. Overlooked extremity fractures in the emergency department. Ulus Travma Acil Cerrahi Derg. 2013; 19(1):25-8.
    13. Moradi A, Kachooei AR, Mudgal CS. Mallet fracture. J Hand Surg Am. 2014;39(10):2067-9.
The Archives of Bone and Joint Surgery
Volume 4, Issue 1 - Serial Number 1
January 2016
Pages 60-64

  • Receive Date 23 February 2015
  • Revise Date 21 June 2015
  • Accept Date 12 July 2015