Children’s Urgent Reduction of Forearm Fractures in the Emergency Department (CURFFED): a multi-centre observational audit assessing the initial management of the paediatric forearm and distal radius fractures.
The SW SIC ODN worked collaboratively with regional colleagues to support the delivery of the CURFFED audit in 2024, with results to be shared in 2025. The network are sharing audit details and documents on behalf of the CURFFED steering committee – local audit policies should always be followed.
National findings from the audit were published in April 2026 and can be viewed here (Bone Jt Open 2026;7(4):531–539).
Audit Summary:
Aim: 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.
Findings: The CURFFED Committee are currently reviewing submitted data and audit findings will be shared in 2025.
Colleagues who are members of the SW SIC ODN NHS Futures Platform can access an initial summary of findings which reviews South West practice against the BOA Paediatric Forearm Fracture Standards here.
Learn more about the audit:
Background
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 included two parts: an audit against BOAST standards, and a questionnaire.
Study Aims
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 were:
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.
Methods
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 were identified at their fracture clinic appointment. Data collected includes: age, sex, type of fracture, use of manipulation, use of X-rays, clinic appointments.
Patients records were reviewed to assess compliance with BOAST standards with a minimum of 8 weeks follow-up.
Data was sought from paper and electronic documentation, post-operative imaging and trauma conference discussions.
Part 2: A short questionnaire was 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 was to assess their views on appropriateness of analgesia for reduction and their perceived barriers to early manipulation of these fractures in ED.
Expected Outcomes of the Study
This project assesses national compliance with BOAST standards. It is anticipated that the results (to be shared in 2025) will help to improve patient care by informing future research and changing clinical practice.
Why Get Involved in the Study?
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)
Study Documents
Click on the titles below to open the study documents:
1. CURFFED study protocol
2. Step-by-step guide
3. FAQs
4. Data collection form example - DO NOT USE: a protected document will be sent on registration
5. Data collection guide
6. CURFFED audit proposal form
7. Caldicott Guardian email template
Contact Details
Please contact CURFFEDproject@gmail.com if you have any questions on the CURFFED audit.
Investigators
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)