NDLI: Evidence into practice: pediatric orthopaedic surgeon use of removable splints for common pediatric fractures.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Boutis, Kathy Howard, Andrew Constantine, Erika Cuomo, Anna Somji, Zeeshanefatema Narayanan, Unni G.
Spatial Coverage	North America
Description	Country affiliation: Canada Author Affiliation: Boutis K ( *Department of Pediatrics, Division of Emergency Medicine Division of Orthopaedic Surgery, Department of Surgery, The Hospital for Sick Children and University of Toronto, Toronto, ON Departments of Emergency Medicine and Pediatrics, Section of Pediatric Emergency Medicine, Alpert Medical School of Brown University §Rhode Island Hospital/Hasbro Children's Hospital, Providence, RI â¥Department of Orthopedic Surgery, Shriners Hospital for Children (Los Angeles), University of California, Los Angeles, CA.)
Abstract	OBJECTIVES: Removable splints when compared with circumferential casts in randomized trials have been shown to be a safe and cost-effective method of managing many common minor distal radius and fibular fractures. This study estimated the extent to which this evidence is being implemented in clinical practice, and determined the perceived barriers to the adoption of this evidence. METHODS: A cross-sectional survey of practicing orthopaedic surgeon members of the Pediatric Orthopedic Surgeons of North America (POSNA) was conducted, using a 22-item online questionnaire, and distributed using a modified Dillman technique. Survey questions were derived from and validated by literature review, expert opinion, and pilot-testing on the targeted sample before implementation. RESULTS: Of the 826 eligible participants, 558 (67.6%) responded to the survey. Of these, 505 (90.5%) had completed a fellowship in pediatric orthopaedics, 335 (60.0%) worked in a university-affiliated setting, and 377 (67.6%) had been in practice for <20 years. Only 158/543 [29.1%; 95% confidence interval (CI), 25.28, 32.92] reported using a removable splint to treat buckle fractures of the distal radius; 32 (5.9%; 95% CI, 3.9, 7.9) and 8 (1.5%; 95% CI, 0.5, 2.5) would use such splints for minimally displaced greenstick and transverse fractures of the distal radius, respectively. For distal fibular avulsion fractures, 122 (22.5%; 95% CI, 19.0, 26.0) would use a removable splint; 57 (10.5%; 95% CI, 7.9, 13.1) and 28 (5.6%; 95% CI, 3.7, 7.5) would do so for nondisplaced Salter-Harris I and II fractures of the distal fibula, respectively. The most commonly reported perceived barriers to application of a removable device were concerns about patient compliance, potential complications, and possible medicolegal implications. CONCLUSIONS: Only a relatively small proportion of practicing POSNA use such splints for minor distal radius and distal fibular fractures. These data support the need for implementation of knowledge translation strategies (eg, education) targeted at all the stakeholders to encourage pediatric orthopaedic surgeons to change practice in keeping with the best evidence for these common and stable injuries. LEVEL OF EVIDENCE: Level II.
File Format	HTM / HTML
ISSN	02716798
Issue Number	1
Volume Number	35
e-ISSN	15392570
Journal	Journal of Pediatric Orthopaedics
Language	English
Publisher	Lippincott Williams & Wilkins
Publisher Date	2015-01-01
Publisher Place	United States
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Discipline Orthopedics Casts, Surgical Utilization Fibula Fracture Fixation Professional Practice Statistics & Numerical Data Radius Fractures Surgery Splints Child Cross-sectional Studies Evidence-based Practice Female Injuries Instrumentation Methods Health Services Needs And Demand Humans Male North America Orthopedics Patient Compliance Pediatrics Physician's Practice Patterns Reproducibility Of Results Questionnaires Journal Article
Content Type	Text
Resource Type	Article
Subject	Orthopedics and Sports Medicine Pediatrics, Perinatology and Child Health

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