Early Management of Paediatric Wrist and Forearm Fractures in a Busy District General Hospital Emergency Department: A Retrospective Cohort Comparison Study and Audit of BOAST Guidelines

Introduction: In response to the strain that the COVID-19 pandemic put on hospitals in the UK, the British Orthopaedic Association, in May 2021, set out British Orthopaedic Association Standards for Trauma and Orthopaedics (BOAST) guidelines for the early management of distal forearm fractures in children. Following this, a local pathway was introduced at our Trust to manage these injuries in the Emergency Department (ED). The aim of this audit was to monitor compliance with the BOAST guidelines and compare the practice with a similar pre-COVID cohort. Methods: A fixed-date retrospective cohort study was conducted that included cases that presented to the emergency department during a six-month period (August 1, 2021 to January 31, 2022). Data was analysed for rates of primary ED manipulation, documentation of consent and neurovascular status in the notes, orthogonal X-ray data, time till the clinic follow-up, theatre time saved and complications. The ED fracture manipulation rate was also compared with another similar pre-COVID cohort (August 1, 2019 to January 31, 2020) to look for any improvement in the practice. Results: A total of 86.31% cases were found to have primary fracture manipulation in the ED following the introduction of Trust guidelines in accordance with the BOAST recommendations. This is an improvement in comparison to the 31.94% fracture manipulation rate before the COVID pandemic. Conclusion: Implementation of the Trust pathway in accordance with the BOAST guidelines along with staff education has standardized the practice at our Trust. It saved approximately 63 hours of trauma theatre time for the six-month data collection period. Our findings also suggest that this has favourable outcomes for the patients with no complications.