O0802 Oct.3: 1:30pm - Pediatric Radial Neck Fractures: Outcomes of an Attempted Closed Reduction in the Emergency Department

Purpose: The purpose of this study is to examine pediatric patients (under the age of 18) with a radial neck fracture, and determine the factors associated with a failed closed reduction (CR) in the Emergency Department (ED). We aim to use these factors to recommend a protocol that guides the treatment management of these fractures.

Methods: 70 patients who presented to our ED with acute radial neck fractures were retrospectively reviewed. Inclusion criteria were: age 18 years or younger at time of injury, diagnosis of radial neck fracture without other associated elbow fractures, an attempt at CR with manipulation in the ED or immediate surgery, open proximal radial physis, and appropriate imaging to categorize the injury. Charts were reviewed and demographic data was obtained for interval of time between injury and initial treatment (CR or surgery). Initial injury radiographs (elbow AP and lateral views) were reviewed to measure degree of angulation, amount of displacement (mm), and translation (%). The Judet classification was used to define the fracture types/categories.

Results: CR was attempted on 41 patients. 29 patients went straight to surgery without a CR attempt. Compared to patients that had an attempted CR in the ED, patients that went straight to surgery had a higher average BMI %ile (85.3 (p = 0.036)), longer mean time from injury to ED presentation (5.6 days (p = 0.0001)) (Table 1), greater mean fracture angulation (55.0° (p = 0.001)) (Table 2), and greater fracture translation (46.2% (p = 0.001)). The CR success rates for each Judet classification were as follows: 100% for Type I (1/1), 100% for Type II (4/4), 33.3% for Type III (8/24), 0% for Type IV (0/10), and 50% for Type V (1/2). When analyzing the patients that had a CR attempted in the ED, univariate statistical analysis demonstrated that ≥ Judet 4 classification (p = 0.03), greater amounts of fracture angulation (p = 0.003), and a treatment delayed greater than 24 hours from injury (p= 0.007) were significant risk factors for failure of CR in the ED. Zero (0/10) patients with fracture angulation ≥60° had a successful CR. Only 1/14 patients presenting ˃24 hours after injury had a successful CR in the ED.

Conclusions: Bypassing a CR attempt under sedation in the ED, and instead splinting for a planned surgical intervention may be a more efficient treatment method for pediatric radial neck fractures that present to the ED more than 24 hours after injury and/or have angulations ≥60°. Adopting this new strategy may decrease patient throughput time in the ED, reduce costs, and avoid possible harm/complications associated with sedation and radiation exposure in the ED.