Improving Patient Care and Streamlining Follow-Up: Compliance With National Institute for Health and Care Excellence (NICE) Guidelines for Pediatric Distal Radius Buckle Fractures

Abstract

Torus fractures, also known as buckle fractures, are among the most common types of fractures seen in children who present to the emergency department (ED). These injuries usually occur when a child falls onto an outstretched hand, resulting in the compression and buckling of the dorsal cortex of the radius while the volar cortex remains intact. These fractures generally have a good prognosis and heal well with simple immobilization with a low risk of complications. However, current treatment practices often involve using a rigid cast and scheduling multiple follow-up clinic visits, which increases the hospital's financial strain. We conducted an initial audit that reviewed the practice in our unit between August and October 2017 at Queen's Hospital, Burton Upon Trent, United Kingdom. It included all children below the age of 16 who had radiograph images confirming distal radius buckle fractures and have been referred to the fracture clinic. Patient demographics, clinic visits, treating doctor grade/specialty, radiographs, initial and final treatment outcomes, and cast application were collected. After the initial audit, compliance with National Institute for Health and Care Excellence (NICE) guidelines was promoted through the education of healthcare providers. A second audit was performed within 12 months to reassess the compliance.