Follow-up care of minor wrist fractures may be handled by primary care physicians, study shows

By Emily De Medeiros

A study led by The Hospital for Sick Children (SickKids) examined 180 children with a type of wrist fracture called a "distal forearm buckle fracture" that were treated with a removable splint and then referred to their primary care physician for reassessment. The authors examined how often this treatment strategy was successful and safe for patients with this common injury. This study was published in the January 4 online edition of Pediatrics.

They found that 87 per cent of the patients received follow-up care exclusively from a primary care physician, seven per cent received a second opinion and about six per cent opted out of any physician follow-up care.

Frequently, these children are first treated in the emergency department and are then advised to see an orthopaedic surgeon for reassessment at a later date. According to the study’s lead author, Dr. Kathy Boutis, Staff Physician in Paediatric Emergency Medicine and Senior Associate Scientist at SickKids, these injuries rarely require an intervention by an orthopaedic specialist, and could likely be managed by a primary care physician such as a paediatrician or family physician. However, previous studies suggest that primary care physicians may not have expertise to care for these musculoskeletal injuries.  A “buckle fracture” of the distal forearm is a minor wrist injury that represents about 50 per cent of all wrist fractures in children. It typically heals very well and can be safely treated with a removable splint.

In the new study, “all children received the same treatment regardless  of whether they were seen by either a primary care physician or an orthopaedic surgeon, and families that visited a primary care physician were very satisfied with the care for this type of injury,” says lead author Boutis, who is also an Associate Professor in Paediatrics at the University of Toronto. “We believe this study provides very good evidence to support follow-up of distal forearm buckle fractures in the primary care office.”  

All of the children recovered as expected for this injury, regardless of the type of follow-up care they received. Although the study notes that a small proportion of practitioners may benefit from further training on anticipatory guidance for these injuries, the majority were found to have the expertise needed to provide care for these injuries. Therefore, findings suggest minor wrist fractures can be handled by a primary care physician, which can be a more convenient option for both families and the health-care system.

This research was supported by the Paediatric Research Academic Initiative at SickKids Emergency (PRAISE) program.

This paper is an example of how SickKids is contributing to making Ontario Healthier, Wealthier and Smarter.