title: Primary Care Physician Follow-up of Distal Radius Buckle Fractures.
abstract: OBJECTIVE
  Our main objective was to determine the proportion of children referred to a primary care provider (PCP) for follow-up of a distal radius buckle fracture who subsequently did not deviate from this reassessment strategy.
  
  
  METHODS
  This prospective cohort study was conducted at a tertiary care pediatric emergency department (ED). Eligible children were aged 2 to 17 years with a distal radius buckle fracture treated with a removable splint and referred to the PCP for reassessment. We telephoned families 28 days after their ED visit. The primary outcome was the proportion who received PCP follow-up exclusively. We also measured the proportion who received PCP anticipatory guidance and those children who reported returning to usual activities "always" by 4 weeks.
  
  
  RESULTS
  We enrolled 200 children, and 180 (90.0%) received telephone follow-up. Of these, 157 (87.2% [95% confidence interval: 82.3 to 92.1]) received PCP follow-up exclusively. Specifically, 11 (6.1%) families opted out of physician follow-up, 5 (2.8%) self-referred to an ED, and the PCP requested specialty consultation in 7 (3.9%) cases. Of the 164 with a PCP visit, 77 (47.0%) parents received anticipatory guidance on return to activities for their child, and 162 (98.8%) reported return to usual activities within 4 weeks.
  
  
  CONCLUSIONS
  The vast majority of children with distal radius buckle fractures presented to the PCP for follow-up and did not receive additional orthopedic surgeon or ED consultations. Despite a suboptimal rate of PCP advice on return to activities, almost all parents reported full return to usual activities within 4 weeks.
authors.affiliation: Division of Emergency Medicine, Department of Pediatrics, McMaster University Medical Centre and McMaster University, Hamilton, Ontario, Canada;
authors.forename: Eric
authors.initials: E
authors.lastname: Koelink
authors.affiliation: Division of Emergency Medicine, Department of Pediatrics.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Schuh
authors.affiliation: Division of Orthopedics, Department of Surgery, and.
authors.forename: Andrew
authors.initials: A
authors.lastname: Howard
authors.affiliation: Division of Orthopedics, Department of Surgery, and.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Stimec
authors.affiliation: Department of Diagnostic Imaging, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.
authors.forename: Lorena
authors.initials: L
authors.lastname: Barra
authors.affiliation: Division of Emergency Medicine, Department of Pediatrics, kathy.boutis@sickkids.ca.
authors.forename: Kathy
authors.initials: K
authors.lastname: Boutis
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011320:Primary Health Care; D011446:Prospective Studies; D011885:Radius Fractures / Q000175:diagnosis / Q000628:therapy; D012017:Referral and Consultation