title: Buckle fractures in children: Is urgent treatment necessary?
abstract: OBJECTIVE
  To determine whether the clinical outcome of buckle fractures in children differs between those treated acutely on the same day of trauma and those treated subacutely, and whether a change in practice patterns based on these data would result in cost savings.
  
  
  METHODS
  In this retrospective cohort study-approved by the institutional review board-we reviewed the cases of 341 consecutive patients younger than 18 years of age seen by the pediatric orthopedic clinic for treatment of isolated extremity buckle fractures between July 1, 2004 and August 31, 2007. Time from injury to treatment was used to divide patients into 2 groups: acute (1 day or less; n=155) and subacute treatment (more than 1 day; n=186). Clinical outcome at final orthopedic follow-up was recorded for each patient. We defined adverse outcome as fractures requiring manipulation, clinically apparent deformity, or functional impairment. Charge analysis compared differences in management costs for patients with buckle fractures presenting initially to the emergency department (ED) and those seen solely in the orthopedic clinic.
  
  
  RESULTS
  No adverse outcomes were identified in either acute or subacute treatment groups. Total clinical visits did not vary (acute, 3.2 vs subacute, 3.1; P=.051). Presence of mild angulation of fractures on radiographs did not differ significantly between acute and subacute management groups at initial presentation (6.5% vs 8.6%; P=.541) or at final follow-up (12.2% vs 12.4%; P=1.0). A cost savings of approximately $3000 could have been realized for each patient referred to the ED who might otherwise have been seen subacutely in the orthopedic clinic.
  
  
  CONCLUSIONS
  No adverse clinical outcomes resulted from subacute treatment of stable buckle fractures. Cost and time savings may be realized with subacute management of buckle fractures without affecting clinical outcome.
authors.affiliation: Department of Radiology and Radiological Sciences, Vanderbilt Children's Hospital, Nashville, TN, USA. dlbennett@partners.org
authors.forename: Debbie Lee
authors.initials: DL
authors.lastname: Bennett
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Mencio
authors.forename: Marta
authors.initials: M
authors.lastname: Hernanz-Schulman
authors.forename: Bobbi J
authors.initials: BJ
authors.lastname: Nealy
authors.forename: Bruce
authors.initials: B
authors.lastname: Damon
authors.forename: J Herman
authors.initials: JH
authors.lastname: Kan
mesh_terms: D000293:Adolescent; D000554:Ambulatory Care Facilities / Q000191:economics*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003365:Costs and Cost Analysis; D004632:Emergency Medical Services / Q000191:economics*; D004638:Emergency Treatment / Q000191:economics; D005260:Female; D050723:Fractures, Bone / Q000628:therapy*; D017048:Health Care Costs; D006801:Humans; D007223:Infant; D008297:Male; D019637:Orthopedic Procedures / Q000191:economics*; D012017:Referral and Consultation; D012189:Retrospective Studies; D013997:Time Factors