title: Consistency between emergency department and orthopedic physicians in the diagnosis and treatment of distal fibular Salter Harris I fractures.
abstract: OBJECTIVE
  The objective was to determine diagnostic and management differences between emergency physicians (EPs) and orthopedic physicians (OPs) for patients with distal fibular physis pain without radiographic fracture.
  
  
  METHODS
  Records from patients with emergency department ankle radiographs between January 2006 and March 2008 were reviewed. Inclusion criteria included trauma, fibular physis pain, normal radiographs, and orthopedic follow-up.
  
  
  RESULTS
  Of 1343 patients, 247 met criteria. Emergency physician diagnoses included Salter Harris (SH) I fracture 198 (80%), sprain 5 (2%), other fracture 24 (10%), or other injury 20 (8%). Orthopedic physician diagnoses included SH I fracture 136 (55%), sprain 48 (19%), other fracture 56 (23%), or other injury 7 (3%). Emergency physicians were more likely to diagnose SH I fracture (P = 0.01). Thirty-six patients diagnosed with SH I fracture by EPs were diagnosed by OPs with different fractures, whereas 40 had sprains and 5 had other injuries. A total of 173 (70%) patients were diagnosed with fractures by both EPs and OPs. On the basis of orthopedists diagnosis, EPs did not diagnose 19 (8%) fractures (P = 0.8). EP treatment included splint 157 (64%), boot 82 (33%), air cast 3 (1%), or cast 5 (2%). Orthopedic physician's treatment included splint 2 (1%), boot 46 (19%), air cast 11 (4%), cast 167 (67%), or none 21 (9%).
  
  
  CONCLUSIONS
  Although EPs diagnosed SH I fracture more frequently than OPs, few fractures were missed. Most patients required ongoing immobilization by OPs regardless of final diagnosis. Suspected SH I fractures should be immobilized and referred for orthopedic evaluation.
authors.affiliation: Department of Pediatrics, Division of Emergency Medicine, Alfred I. duPont Hospital for Children, Jefferson Medical College, 1600 Rockland Rd, PO Box 269, Wilmington, DE 19899, USA. azomorro@nemours.org
authors.forename: Arezoo
authors.initials: A
authors.lastname: Zomorrodi
authors.forename: Jonathan Eric
authors.initials: JE
authors.lastname: Bennett
authors.forename: Magdy William
authors.initials: MW
authors.lastname: Attia
authors.forename: John
authors.initials: J
authors.lastname: Loiselle
authors.forename: Kenneth John
authors.initials: KJ
authors.lastname: Rogers
authors.forename: Richard
authors.initials: R
authors.lastname: Kruse
mesh_terms: D000293:Adolescent; D016512:Ankle Injuries / Q000175:diagnosis* / Q000628:therapy*; D002358:Cartilage, Articular / Q000293:injuries*; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D005260:Female; D050723:Fractures, Bone / Q000175:diagnosis* / Q000628:therapy*; D050724:Fractures, Cartilage / Q000175:diagnosis* / Q000628:therapy*; D006801:Humans; D008297:Male; D009985:Orthopedics; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies