Carson D. Strickland, MD1 Robert Neel, BS2 Evan Porter, MD1 Benjamin W. Sheffer, MD1 Derek M. Kelly, MD1 1
University of Tennessee-Campbell Clinic Department of Orthopaedic Surgery & Biomedical Engineering Memphis, Tennessee
2 University of Tennessee Health Science Center College of Medicine Memphis, Tennessee
Closed Reductions of Pediatric Wrist, Forearm, and Elbow Fractures in a Free-Standing Ambulatory Surgery Center is a Safe and Cost-effective Alternative to the Emergency Department Background Pediatric extremity fractures and dislocations have historically been treated on the day of presentation to the pediatric emergency department (PED). As the use of ambulatory surgery centers (ASCs) has increased, so has delayed treatment of these injuries in an outpatient setting.
Objectives The goal of this study was to examine clinical and radiographic outcomes, as well as length of stay, in the treatment of pediatric upper extremity fractures below the elbow in the pediatric ED, hospital ASC (hASC), and a free-standing ASC (fASC).
Methods A retrospective chart review identified pediatric patients who had closed manipulation and immobilization of upper extremity injuries distal to the elbow from October 2013, to December 2018. We specifically looked at 3 venues of care: a level 1 PED, a hASC, and a fASC. There were 95 and 99 patients in the hASC and fASC cohorts, respectively. To match these numbers, the first 99 patients in the PED group were considered. The primary outcomes were length of visit, length of sedation, time from admission to procedure, time from initial presentation to reduction in the outpatient groups, post-procedure radiographic parameters of angulation and change in angulation, procedural complications, need for remanipulation, and need for conversion to open treatment.
Results
Corresponding Author Derek M. Kelly, MD 1458 W. Poplar Avenue, Suite 100 Collierville, TN 38017 P: 901-759-5552 F; 901-435-5654 dkelly@campbellclinic.com
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There was a significant difference in the length of visit between all groups, with the fASC being about 80 and 73 minutes shorter compared to the PED and hASC groups, respectively (p<0.05). There was no significant difference amongst the groups for length of sedation. On average, patients waited approximately 193 minutes prior to reduction in the PED compared to 83 minutes at the fASC and 143 minutes at the hASC, which was significant (p<0.05). Pre- and post- radiographic fracture angulation and displacement were similar for the groups. There were no procedural complications for any of the groups, and there was no significant difference in the rates of remanipulation and conversion to open treatment.
CAMPBELL ORTHOPAEDIC JOURNAL • VOLUME 7, 2021
