CURFFED Project – Spring 2024

Children’s Urgent Reduction of Forearm Fractures in the Emergency Department (CURFFED)

The SW SIC ODN are working collaboratively with regional colleagues to support the delivery of the CURFFED audit. The network are sharing the audit details and documents on behalf of the CURFFED steering committee – local audit policies should always be followed.

Audit Summary:

Aim: The primary aim is to determine how children’s paediatric forearm and distal radius fractures are managed in the United Kingdom in comparison to BOAST standards

Hospital eligibility: Any hospital in the United Kingdom managing paediatric forearm and distal radius fractures.

Inclusion criteria: Consecutive patients less than 16 years’ old undergoing manipulation of paediatric forearm and distal radius fractures attending fracture clinic.

Team: Individual hospital teams made up of four people including a consultant Team Lead

Time period: Injuries sustained between 00:00 1st March 2024 and 23:59 30th April 2024 with follow-up to extend up to 7th July.

Registration: Interested collaborators should register online – click here or scan the QR code to register.

Forearm and distal radius fractures are the most common site of fracture in children. Most of these fractures can be managed without procedural intervention. If manipulation is required, the majority benefit from being performed early in the Emergency Department, thus avoiding the need for admission and a general anaesthetic. National standards have been introduced to improve the care of these patients (BOA, 2021).

The Getting It Right First Time (GIRFT) Programme identified great variability in the management of these injuries between units and found that a significant proportion of patients are undergoing manipulation under anaesthesia in the operating theatre (GIRFT, 2022). This is often despite patients being deemed appropriate for manipulation in the ED and high patient and parental acceptability of this process (BOA, 2022).

The study will be organised in two parts: an audit against BOAST standards, and a questionnaire.

The primary aim of the audit is to determine how children’s paediatric forearm and distal radius fractures are managed in the United Kingdom in comparison to BOAST standards.

The aims of the questionnaire are:
1) To assess potential barriers to early manipulation of paediatric forearm and distal radius fractures in the Emergency Department
2) To assess ED and T&O clinicians’ views on the most appropriate form of analgesia for manipulation of  these fractures.

Part 1: Patients aged 0-16 years old sustaining a forearm or distal radius fracture between 00:00 1st March 2024 and 23:59 30th April 2024 will be identified at their fracture clinic appointment. Data to be collected includes: age, sex, type of fracture, use of manipulation, use of X-rays, clinic appointments.

Patients records will then be reviewed to assess compliance with BOAST standards with a minimum of 8 weeks follow-up.

Data will be sought from paper and electronic documentation, post-operative imaging and trauma conference discussions.

Part 2: A short questionnaire to be completed by ED and T&O registrars, trust grades, associate specialists and consultants involved in the management of paediatric forearm and distal radius fractures. This will assess their views on appropriateness of analgesia for reduction
and their perceived barriers to early manipulation of these fractures in ED.

This project will assess national compliance with BOAST standards. It is anticipated that the results will help to improve patient care by informing future research and changing clinical practice.

1) Taking part fulfils your ARCP requirement of audit completion

2) You get to be a listed author of a large, multicentre, trainee-led audit which will add
points to your specialty applications (specialty dependent) and fulfil publication
requirements for ARCP, with minimal effort

3) National data dissemination will help improve paediatric distal radius and forearm
fracture care across the country

4) By performing a second loop of this audit separately you will be able to improve
patient care in your local department (or using this study opportunity to close an
audit loop if a similar audit has previously been undertaken at your Trust)

Please contact CURFFEDproject@gmail.com if you have any questions on the CURFFED audit.

Steering Committee:
Mr Rob Whitham, Specialty Registrar, Royal United Hospital
Mr Luke Duggleby, Specialty Registrar, Royal United Hospital
Mr Lysander Gourbault, Specialty Registrar, Gloucester Royal Hospital
Mr Alexander Christie, Specialty Registrar, Royal United Hospital
Ms Erin Jones, Core Surgical Trainee, Royal United Hospital
Mr Andrew Womersley, Core Surgical Trainee, Royal United Hospital

Project Advisors:
Mr Guy Atherton, Consultant Paediatric Orthopaedic Surgeon, Bristol Children’s Hospital, and British Society for Children’s Orthopaedic Surgery (BSCOS) President

Project Support:
South West Surgery in Children Operational Delivery Network (SW SIC ODN)
Bristol Orthopaedic Registrars’ Group (BORG)