Factors affecting management of children's low-risk distal radius fractures in the emergency department: a population-based retrospective cohort study.

Tara Baxter, Teresa To, Maria Chiu, Mark Camp, Andrew Howard

Abstract read

In one paragraph

Article in CMAJ open. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it

0cells of the map it votes in

1citing papers in PubMed

–field-weighted citation impact

1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

Soft bandages in buckle fracture treatment.Canadian family physician Medecin de famille canadien · 2026
Article

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

Tara BaxterDivision of Orthopaedic Surgery (Baxter), Faculty of Medicine, University of Toronto; Child Health Evaluative Sciences (To), The Hospital for Sick Children; ICES (Chiu); Division of Epidemiology (Chiu), University of Toronto; Department of Surgery (Camp), The Hospital for Sick Children; Division of Orthopaedics (Howard), Department of Surgery, The Hospital for Sick Children, Toronto, Ont. tara.baxter@medportal.ca.

Teresa ToDivision of Orthopaedic Surgery (Baxter), Faculty of Medicine, University of Toronto; Child Health Evaluative Sciences (To), The Hospital for Sick Children; ICES (Chiu); Division of Epidemiology (Chiu), University of Toronto; Department of Surgery (Camp), The Hospital for Sick Children; Division of Orthopaedics (Howard), Department of Surgery, The Hospital for Sick Children, Toronto, Ont.

Maria ChiuDivision of Orthopaedic Surgery (Baxter), Faculty of Medicine, University of Toronto; Child Health Evaluative Sciences (To), The Hospital for Sick Children; ICES (Chiu); Division of Epidemiology (Chiu), University of Toronto; Department of Surgery (Camp), The Hospital for Sick Children; Division of Orthopaedics (Howard), Department of Surgery, The Hospital for Sick Children, Toronto, Ont.

Mark CampDivision of Orthopaedic Surgery (Baxter), Faculty of Medicine, University of Toronto; Child Health Evaluative Sciences (To), The Hospital for Sick Children; ICES (Chiu); Division of Epidemiology (Chiu), University of Toronto; Department of Surgery (Camp), The Hospital for Sick Children; Division of Orthopaedics (Howard), Department of Surgery, The Hospital for Sick Children, Toronto, Ont.

Andrew HowardDivision of Orthopaedic Surgery (Baxter), Faculty of Medicine, University of Toronto; Child Health Evaluative Sciences (To), The Hospital for Sick Children; ICES (Chiu); Division of Epidemiology (Chiu), University of Toronto; Department of Surgery (Camp), The Hospital for Sick Children; Division of Orthopaedics (Howard), Department of Surgery, The Hospital for Sick Children, Toronto, Ont.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundTen randomized controlled trials over the last 2 decades support treating low-risk pediatric distal radius fractures with removable immobilization and without physician follow-up. We aimed to determine the proportion of these fractures being treated without physician follow-up and to determine whether different hospital and physician types are treating these injuries differently.

methodsWe conducted a retrospective population-based cohort study using ICES data. We included children aged 2-14 years (2-12 yr for girls and 2-14 yr for boys) with distal radius fractures having had no reduction or operation within a 6-week period, and who received treatment in Ontario emergency departments from 2003 to 2015. Proportions of patients receiving orthopedic, primary care and no follow-up were determined. Multivariable log-binomial regression was used to quantify associations between hospital and physician type and management.

resultsWe analyzed 70 801 fractures. A total of 20.8% (

interpretationWhile small hospital emergency departments, pediatricians and pediatric emergency medicine specialists were most likely to manage low-risk distal radius fractures without follow-up, the majority of these fractures in Ontario were not managed according to the latest research evidence. Canadian guidelines are required to improve care of these fractures and to reduce the substantial overutilization of physician resources we observed.

Indexed as

AftercareConservative TreatmentRadius FracturesChildChild Health ServicesEmergency Service, HospitalFemaleHumansMaleMedical OveruseOntarioOrthopedicsPediatric Emergency MedicinePractice Patterns, Physicians'Quality Improvement

Identifiers

PMID34131029

DOI10.9778/cmajo.20200116

PMCPMC8248581

What OpenQuestion holds

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LicenceCC BY-NC-ND

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.