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Original research
Retrospective chart review of minor tibial fractures in preschoolers: immobilisation and complications
  1. Charlotte A Ferrier1,
  2. Rachel Schembri2,
  3. Sandy M Hopper3,4
  1. 1 Melbourne Clinical School, The University of Notre Dame Australia Melbourne Clinical School, Werribee, Victoria, Australia
  2. 2 Murdoch Childrens Research Institute, Parkville, Victoria, Australia
  3. 3 Emergency Department, Royal Children’s Hospital Melbourne, Parkville, Victoria, Australia
  4. 4 Faculty of Medicine, Dentistry and Health Sciences, Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
  1. Correspondence to Dr Sandy M Hopper, Emergency Department, Royal Children’s Hospital Melbourne, Parkville, VIC 3052, Australia; sandy.hopper{at}rch.org.au

Abstract

Objective To compare the treatment practices (immobilisation vs non-immobilisation) of toddler fractures and other minor tibial fractures (both proven and suspected) in preschoolers, aged 9 months–4 years, and examine rates of ED re-presentations and complications.

Methods Retrospective chart review of presentations of minor tibial fractures, both proven (radiologically confirmed) or suspected (negative X-ray but clinical evidence of bony injury), in children aged 9 months–4 years presenting to a single tertiary level paediatric ED from May 2016 to April 2018. Data collected included treatment practices, subsequent unscheduled re-presentations (including reasons) and complications (defined as problems relating to the injury that required further active care).

Results A search of medical records yielded 240 cases: 102 had proven fractures (spiral, buckle or Salter-Harris II) and 138 were diagnosed with a suspected fracture. 73.5% of proven fractures were immobilised, predominantly with backslabs. 79% of suspected fractures were treated with expectant observation without immobilisation. Patients treated with immobilisation were more likely to re-present to ED compared with non-immobilised patients (18/104, 17.3% vs 9/136, 6.6% RR 2.62, 95% CI 1.23 to 5.58). 21 complications were seen in 19/104 (18.3%) immobilised patients. There were eight skin complications (complication rate of 7.7%) and 11 cast issues (complication rate of 10.6%). Two (1.5%) of the 136 patients had complications related to pain or limp. Pain was uncommonly found, although follow-up was not universal.

Conclusion In our centre, proven minor tibial fractures were more likely to receive a backslab, whereas for suspected fractures, expectant observation without immobilisation was performed. Although there is potential bias in the identification of complications with immobilisation, the study suggests that non-immobilisation approach should be investigated.

  • tibial fracture
  • toddler’s fracture
  • immobilisation
  • spiral fracture
  • skin breakdown

https://doi.org/10.1136/emermed-2019-208930

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    Footnotes

    • Contributors CAF and SMH designed the study, abstracted the data and prepared the manuscript. RS designed and implemented the analysis and statistical plan and contributed to the manuscript. SMH is responsible for the overall content as guarantor.

    • Funding The study was supported in part by the Victorian Government’s Infrastructure Support Program, Melbourne, Australia.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Patient consent for publication Not required.

    • Ethics approval Ethical approval was obtained from The Royal Children’s Hospital Melbourne Human Research Ethics Committee (HREC), reference number 37277A and the HREC of the University of Notre Dame Australia, reference number 017182S.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available on reasonable request. Data are stored in unidentifiable form at the Murdoch Children’s Research Institute in a secure database. Data may be available for further study subject to a reasonable request.