Department of Orthopaedics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA.
Iowa Orthop J. 2020;40(2):12-20.
Pediatric buckle fractures of the wrist can be safely managed in 'minimalist' fashion with splinting and limited follow-up; however, traditional means of treatment remain prevalent. The purpose of this study was to 1) evaluate preferences for buckle fracture management among providers at a single institution and 2) identify factors influencing clinical decision-making and barriers to implementation of minimalist practices.
A 13 question survey was developed split into three sections: 1) Demographics, 2) Preferred management, and 3) Influential factors. The survey was distributed to 32 providers within our hospital system involved in buckle fracture management via email over a 1 year period. Descriptive statistics of responses were performed to address study aims.
The survey participation rate was 72%. Respondents had 12.2+/-12.5 (Range: 1-41) years of experience. Casting of buckle fractures was preferred by 56.5% of providers. Most (77%) were aware of literature supporting minimalist strategies. Family preferences (59.1%) and compliance concerns (54.5%) were cited as the biggest barriers to implementing these practices. Colleague recommendations and patient and caregiver preferences had the strongest influence on providers' practice. Following completion, 88.2% of providers stated they would change or consider changing their practices.
Despite awareness of the evidence base, a casting preference still exists. While other aspects of the minimalist approach were popular, prior work suggests this does not necessarily translate into practice. Commonly cited barriers include family preferences and compliance concerns; however, awareness of these issues may enable change. .
小儿腕部 buckle 骨折通过夹板固定和有限的随访，可以安全地进行“极简主义”治疗；然而，传统的治疗方法仍然很普遍。本研究的目的是：1）评估单一机构的提供者对 buckle 骨折治疗的偏好；2）确定影响临床决策的因素以及实施极简主义实践的障碍。
我们开发了一个包含 13 个问题的调查，分为三个部分：1）人口统计学资料，2）首选管理方法，3）影响因素。在 1 年内，通过电子邮件向我们医院系统内参与 buckle 骨折管理的 32 名提供者分发了这份调查问卷。通过描述性统计分析来解决研究目的。
调查的参与率为 72%。应答者的经验为 12.2+/-12.5 年（范围：1-41 年）。56.5%的提供者首选对 buckle 骨折进行石膏固定。大多数（77%）人知道支持极简主义策略的文献。实施这些实践的最大障碍是家庭偏好（59.1%）和合规性担忧（54.5%）。同事的建议和患者及照顾者的偏好对提供者的实践影响最大。88.2%的提供者在完成调查后表示，他们将改变或考虑改变自己的治疗方式。
尽管了解了证据基础，但仍存在石膏固定偏好。虽然极简主义方法的其他方面很受欢迎，但之前的研究表明，这并不一定转化为实践。常见的障碍包括家庭偏好和合规性担忧；然而，对这些问题的认识可能会促使治疗方式发生改变。
