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Pathway to help increase paediatric forearm fracture manipulation in the ED

A pathway supporting hospital clinicians in treating children who present in the emergency department (ED) with a forearm fracture is on offer from the Getting It Right First Time (GIRFT) programme.

The pathway for paediatric forearm fracture manipulation in the ED has been developed through a series of workshops with clinical stakeholders from across the specialties of orthopaedics, paediatric trauma and orthopaedics, emergency medicine, paediatric emergency medicine, and trauma. It outlines best practice at all stages of the patient pathway, from triage and assessment through to discharge and follow-up.

Five professional societies have supported and co-badged pathways: The British Orthopaedic Association (BOA), the Association of Paediatric Emergency Medicine (APEM), the Royal College of Emergency Medicine (RCEM), the British Society for Children’s Orthopaedic Surgery (BSCOS) and the Royal College of Paediatrics and Child Health (RCPCH).

The new resource follows the findings and recommendations of the GIRFT national report for paediatric trauma and orthopaedic surgery (2022), authored by James Hunter, a paediatric trauma and orthopaedic surgeon at the Queen’s Medical Centre, Nottingham.

While a significant proportion of paediatric forearm fractures can be manipulated and cast in the ED at the time of first attendance, the GIRFT report highlighted wide variation across trusts in the number of children aged 16 and under admitted and treated in the operating theatre. It was calculated that more than 250 weeks of operating time a year had been dedicated to manipulation of the forearm and wrist in England between 2016 and 2019, which could be reduced by 80% (to 57 weeks or less) if all trusts can achieve the level of those with well-developed ED manipulation protocols.

The report also highlighted that reducing the number of admissions for simple forearm and wrist fractures has the potential to create efficiencies of £1.6m annually for the NHS.

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