The Children's Urgent Reduction of Forearm Fractures in the Emergency Department (CURFFED) project : a national prospective trainee-led collaborative audit of practice.
Lysander J Gourbault, Robert Whitham, Andrew Womersley, Erin Jones, Alexander Christie, Luke Duggleby, William Guy Atherton, Ben Doughty, Isabella Smith, Abdul Rahman Hassan, Will Levitt, Angharad Davies, Charlotte Carpenter, Shahtajarab Saltanat, Pranai Buddhdev, Hannah Lennox-Warburton, Eoghan Donnelly, Kate Kim, Jowad Farooq, Claire Spolton Dean, Caroline Edwards, Mohamed Mahmoud, Andrew Stone, Adekinte Oyekan, Azal Jalgaonkar, Christopher To, Alex Hunt, Madeleine Garner, Alice Campion, Megan Sison, Sarah Irby, Michael Price, Lokesh Sharoff, Rebecca Worley, Hyder Tahir, Andrew Bircher, Nitin Modi, Emma Theobald, Ahmed Genena, Daniel Carter, Lydia Milnes, Tobias Roberts, Ashish Vasudev, Dylan Green, Alexander Boucher, Ethan Caruana, Omar Khokhar, Prem Kumar, Hamza Rahman, Sheena Seewoonarain, Ruben Thumbadoo, Sophie Forster, Ramanan Vadivelu, Lorna Bagshaw, Bobin Varghese, Srikiran Thalanki, Aubrey Conrad Franco, Laveeza Hamid, Ignatius Liew, Jordon Robinson, Ishani Gurung, Peter Figg, Rob Moverley, Greg Neal-Smith, Kunjan Barot, Thet Paing Oo, Joseph Hanger, Matthew Larsen, Alice Jones, Laura Lougher, Matthew Flintoft-Burt, Spilios Dellis, Tamer Kamal, Sunil Bajaj, Kamalpreet Chema, Moritz Lebe, Gaurav Bhandari, Edward Jeans, Kyle James, Tom Barrow, Leticia Fernandez, Takura Razemba, Russell Hawkins, Kerry Anderson, Laura Tillotson, William Thomas, Eleanor Burden, Sujit Kadambande, Ibrahim Khalil Ibrahim, Mannix O'Boyle, Louise McCormack, Janine O'Donnell, Emily Baird, Fiona MacDonald, Joanna Aithie, Patrick Robinson, Joe Esland, Andrew Keightley, Aman Jain, Dev Thakker, Mayur Nayak, Leticia Caamina, Tom Barrow, David Discalicau, Zoe Lockton, Amjad Burgan, Greg Morris, Rajeev Bansal, Maneesh Sinha, Omar Mostafa, Usman Ishaq, Ahmed Elmorsy, Alex Thomas, Portia Ross, Kanthan Theivendran, Tahir Khaleeq, Edward Lindisfarne, Rohit Gangadharan, Gajendiran Thiruchandran, Khaled Youssef, Andrzej Tober, Nirav Shah, Amir Varasteh, Abhijit Bajracharya, Ahmed Lashin, Max Mifsud, Thomas Lloyd, Christian Kirk, Thomas Ball, Jonathan Sheen, Smriti Kapoor, Iolo Thomas Jones, Douglas Donnachie, Kelly Clamp, Dan Westacott, James Miller, Elizabeth Hedge, Austin Gomindes, Lisa Amour, Jaffar Ibrahim, Jonathan Dwyer, Madeleine Bickley, Emily Fulcher, Ajay Kumar Chourasia, Sherif Hosny, Mohamed Hashem, Agneish Dutta, Darren Leong, Kim Fergurson, Amy Haddock, Minaal Malik, Amir Varasteh, Louise Cruz, Lydia Jenkins, Jamie East, Charlie Oxley
{"title":"The Children's Urgent Reduction of Forearm Fractures in the Emergency Department (CURFFED) project : a national prospective trainee-led collaborative audit of practice.","authors":"Lysander J Gourbault, Robert Whitham, Andrew Womersley, Erin Jones, Alexander Christie, Luke Duggleby, William Guy Atherton, Ben Doughty, Isabella Smith, Abdul Rahman Hassan, Will Levitt, Angharad Davies, Charlotte Carpenter, Shahtajarab Saltanat, Pranai Buddhdev, Hannah Lennox-Warburton, Eoghan Donnelly, Kate Kim, Jowad Farooq, Claire Spolton Dean, Caroline Edwards, Mohamed Mahmoud, Andrew Stone, Adekinte Oyekan, Azal Jalgaonkar, Christopher To, Alex Hunt, Madeleine Garner, Alice Campion, Megan Sison, Sarah Irby, Michael Price, Lokesh Sharoff, Rebecca Worley, Hyder Tahir, Andrew Bircher, Nitin Modi, Emma Theobald, Ahmed Genena, Daniel Carter, Lydia Milnes, Tobias Roberts, Ashish Vasudev, Dylan Green, Alexander Boucher, Ethan Caruana, Omar Khokhar, Prem Kumar, Hamza Rahman, Sheena Seewoonarain, Ruben Thumbadoo, Sophie Forster, Ramanan Vadivelu, Lorna Bagshaw, Bobin Varghese, Srikiran Thalanki, Aubrey Conrad Franco, Laveeza Hamid, Ignatius Liew, Jordon Robinson, Ishani Gurung, Peter Figg, Rob Moverley, Greg Neal-Smith, Kunjan Barot, Thet Paing Oo, Joseph Hanger, Matthew Larsen, Alice Jones, Laura Lougher, Matthew Flintoft-Burt, Spilios Dellis, Tamer Kamal, Sunil Bajaj, Kamalpreet Chema, Moritz Lebe, Gaurav Bhandari, Edward Jeans, Kyle James, Tom Barrow, Leticia Fernandez, Takura Razemba, Russell Hawkins, Kerry Anderson, Laura Tillotson, William Thomas, Eleanor Burden, Sujit Kadambande, Ibrahim Khalil Ibrahim, Mannix O'Boyle, Louise McCormack, Janine O'Donnell, Emily Baird, Fiona MacDonald, Joanna Aithie, Patrick Robinson, Joe Esland, Andrew Keightley, Aman Jain, Dev Thakker, Mayur Nayak, Leticia Caamina, Tom Barrow, David Discalicau, Zoe Lockton, Amjad Burgan, Greg Morris, Rajeev Bansal, Maneesh Sinha, Omar Mostafa, Usman Ishaq, Ahmed Elmorsy, Alex Thomas, Portia Ross, Kanthan Theivendran, Tahir Khaleeq, Edward Lindisfarne, Rohit Gangadharan, Gajendiran Thiruchandran, Khaled Youssef, Andrzej Tober, Nirav Shah, Amir Varasteh, Abhijit Bajracharya, Ahmed Lashin, Max Mifsud, Thomas Lloyd, Christian Kirk, Thomas Ball, Jonathan Sheen, Smriti Kapoor, Iolo Thomas Jones, Douglas Donnachie, Kelly Clamp, Dan Westacott, James Miller, Elizabeth Hedge, Austin Gomindes, Lisa Amour, Jaffar Ibrahim, Jonathan Dwyer, Madeleine Bickley, Emily Fulcher, Ajay Kumar Chourasia, Sherif Hosny, Mohamed Hashem, Agneish Dutta, Darren Leong, Kim Fergurson, Amy Haddock, Minaal Malik, Amir Varasteh, Louise Cruz, Lydia Jenkins, Jamie East, Charlie Oxley","doi":"10.1302/2633-1462.74.BJO-2025-0338.R1","DOIUrl":null,"url":null,"abstract":"<p><strong>Aims: </strong>This audit aimed to assess compliance with British Orthopaedic Association Standards for Trauma (BOAST) for paediatric forearm and wrist fractures across UK NHS hospitals and identify targets for improvement locally and nationally.</p><p><strong>Methods: </strong>This was a prospective, multicentre observational audit of BOAST standards for the Early Management of the Paediatric Forearm Fracture guideline. Consecutive patients aged under 16 years presenting with a forearm or distal radius fracture over a two-month period were included with follow-up to eight weeks post injury. Data were collected to assess each of the BOAST standards for practice. Percentage compliance with all standards was calculated for each hospital.</p><p><strong>Results: </strong>Data from 1,699 patients across 53 hospitals were included. The mean age was 9.7 years (SD 3.6), and 37% (n = 636) were female. Overall, 60% of fractures (n = 1,023) were metaphyseal distal radius fractures. A total of 577 patients (34%) underwent manipulation with the majority initially reduced in the Emergency Department (ED) (n = 423, 73%); 89 (21%) required subsequent theatre manipulation. The median time to first manipulation in the ED was two hours 43 minutes (IQR 1 hr 43 mins to 4 hrs 4 mins) and 18 hours 47 minutes (IQR 13 hrs 48 mins to 24 hrs 2 mins) when first manipulation was performed in theatre. Overall compliance with BOAST standards was 63%, with 20% of patients (n = 85) having pain scores documented, 51% (n = 217) having a complete neurovascular assessment, and 23% (n = 95) receiving analgesia and a patient information leaflet on discharge.</p><p><strong>Conclusion: </strong>This study highlights variability in managing paediatric fractures despite established standards. In line with recommendations, a high proportion of reductions are now being performed in EDs. Particular areas requiring improvement are the management of paediatric pain, documented assessment of neurovascular status, and the provision of patient information. We recommend that hospitals review their current practice and ensure that local protocols are in place to promote the provision of optimal care for this patient group, and to minimize the impact on operating theatre capacity.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 4","pages":"531-539"},"PeriodicalIF":3.1000,"publicationDate":"2026-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13068486/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Bone & Joint Open","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1302/2633-1462.74.BJO-2025-0338.R1","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
引用次数: 0
Abstract
Aims: This audit aimed to assess compliance with British Orthopaedic Association Standards for Trauma (BOAST) for paediatric forearm and wrist fractures across UK NHS hospitals and identify targets for improvement locally and nationally.
Methods: This was a prospective, multicentre observational audit of BOAST standards for the Early Management of the Paediatric Forearm Fracture guideline. Consecutive patients aged under 16 years presenting with a forearm or distal radius fracture over a two-month period were included with follow-up to eight weeks post injury. Data were collected to assess each of the BOAST standards for practice. Percentage compliance with all standards was calculated for each hospital.
Results: Data from 1,699 patients across 53 hospitals were included. The mean age was 9.7 years (SD 3.6), and 37% (n = 636) were female. Overall, 60% of fractures (n = 1,023) were metaphyseal distal radius fractures. A total of 577 patients (34%) underwent manipulation with the majority initially reduced in the Emergency Department (ED) (n = 423, 73%); 89 (21%) required subsequent theatre manipulation. The median time to first manipulation in the ED was two hours 43 minutes (IQR 1 hr 43 mins to 4 hrs 4 mins) and 18 hours 47 minutes (IQR 13 hrs 48 mins to 24 hrs 2 mins) when first manipulation was performed in theatre. Overall compliance with BOAST standards was 63%, with 20% of patients (n = 85) having pain scores documented, 51% (n = 217) having a complete neurovascular assessment, and 23% (n = 95) receiving analgesia and a patient information leaflet on discharge.
Conclusion: This study highlights variability in managing paediatric fractures despite established standards. In line with recommendations, a high proportion of reductions are now being performed in EDs. Particular areas requiring improvement are the management of paediatric pain, documented assessment of neurovascular status, and the provision of patient information. We recommend that hospitals review their current practice and ensure that local protocols are in place to promote the provision of optimal care for this patient group, and to minimize the impact on operating theatre capacity.
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