672 The Management of Distal Radius Buckle Fractures

Aim To evaluate the management of distal radius buckle fractures in children and improve out-patient clinic utilisation. Method From April to June 2023, data was retrospectively collected across 4 emergency departments, including a specialist Children’s hospital, 2 DGH Emergency Departments and an Urgent Care Centre on all children aged 4-15 who had the code of distal radius fracture. Data was collected on the initial treatment comparing casts and splints, the number of out-patient appointments and the complications. These were analysed and the significance calculated using the chi-square test. Results 416 fractures were screened of which 216 fractures were buckle fractures. Of these, 153 (71%) were splinted and 63 (29%) were casted. No patients or carers expressed concern about deformities. 108 patients were directly discharged from the emergency department with 33 patients discharged from the Virtual fracture clinic and other 75 patients generating 124 clinic appointments. Complications included 10 re-attendances to the emergency department for pain/swelling/cast problems/to arrange follow up, 1 re-fracture and 1 pressure sore from a cast. The rate of complications was significantly greater in the cast group (9.5%) vs the splint group (3.3%) (p value = 0.008). Conclusions Casts have a higher rate of re-attendance and complications than splints. Splints should be first line and local ED protocols should be altered to reflect this. Direct discharge from the emergency department is safe and can result in better utilisation of outpatient services. This will be improved locally through a series of education events.