PMID- 24887079
OWN - NLM
STAT- MEDLINE
DCOM- 20150525
LR  - 20220317
IS  - 1539-2570 (Electronic)
IS  - 0271-6798 (Linking)
VI  - 35
IP  - 1
DP  - 2015 Jan
TI  - Evidence into practice: pediatric orthopaedic surgeon use of removable splints 
      for common pediatric fractures.
PG  - 18-23
LID - 10.1097/BPO.0000000000000223 [doi]
AB  - 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.
FAU - Boutis, Kathy
AU  - Boutis K
AD  - *Department of Pediatrics, Division of Emergency Medicine daggerDivision of 
      Orthopaedic Surgery, Department of Surgery, The Hospital for Sick Children and 
      University of Toronto, Toronto, ON double daggerDepartments of Emergency Medicine and 
      Pediatrics, Section of Pediatric Emergency Medicine, Alpert Medical School of 
      Brown University  section signRhode Island Hospital/Hasbro Children's Hospital, Providence, 
      RI  parallelDepartment of Orthopedic Surgery, Shriners Hospital for Children (Los 
      Angeles), University of California, Los Angeles, CA.
FAU - Howard, Andrew
AU  - Howard A
FAU - Constantine, Erika
AU  - Constantine E
FAU - Cuomo, Anna
AU  - Cuomo A
FAU - Somji, Zeeshanefatema
AU  - Somji Z
FAU - Narayanan, Unni G
AU  - Narayanan UG
LA  - eng
PT  - Journal Article
PL  - United States
TA  - J Pediatr Orthop
JT  - Journal of pediatric orthopedics
JID - 8109053
SB  - IM
MH  - Casts, Surgical/*statistics & numerical data
MH  - Child
MH  - Cross-Sectional Studies
MH  - Evidence-Based Practice
MH  - Female
MH  - *Fibula/injuries/surgery
MH  - *Fracture Fixation/instrumentation/methods/statistics & numerical data
MH  - Health Services Needs and Demand
MH  - Humans
MH  - Male
MH  - North America
MH  - Orthopedics/statistics & numerical data
MH  - Patient Compliance
MH  - Pediatrics/statistics & numerical data
MH  - Practice Patterns, Physicians'
MH  - Professional Practice/*statistics & numerical data
MH  - Radius Fractures/*surgery
MH  - Reproducibility of Results
MH  - Splints/*statistics & numerical data
MH  - Surveys and Questionnaires
EDAT- 2014/06/03 06:00
MHDA- 2015/05/26 06:00
CRDT- 2014/06/03 06:00
PHST- 2014/06/03 06:00 [entrez]
PHST- 2014/06/03 06:00 [pubmed]
PHST- 2015/05/26 06:00 [medline]
AID - 10.1097/BPO.0000000000000223 [doi]
PST - ppublish
SO  - J Pediatr Orthop. 2015 Jan;35(1):18-23. doi: 10.1097/BPO.0000000000000223.