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A Cost Comparison of Introducing a Soft Splint Pathway for Management of Distal Radius Buckle Fractures
Hemali Chauhan, MBBS; Kate Spacey, MBBS; Anand Patel, MBBS; Sean Symons, MBBS
Basildon University Hospital, Essex, United Kingdom

Introduction: Distal radius buckle fractures are stable injuries that are manageable in soft casts rather than traditional Plaster of Paris (POP). Soft casts can be removed at home by the parent(s), avoiding unnecessary follow-up appointments. Therefore a soft cast treatment pathway would involve application of the removable soft cast at first appointment and discharge with cast care, removal and mobilisation advice. Aim: We examine our current departmental practice and present a cost comparison of using the proposed soft cast pathway rather than POP.
Methods: We examined the radiographs and notes of all children presenting with distal radial buckle fractures over a 3 month period. Costings were assimilated through plaster room purchasing and the clinical coding department.
Results: All 107 children (61M; 46F), of average age 8.4 years, were placed in POP in the Emergency Department (ED). Approximately 61% of children were managed in POP and 25.2% had unnecessary additional radiographs. Only 33% were discharged at the first clinic appointment. Approximately 85% were reviewed in a dedicated Paediatric fracture clinic, where patients are twice as likely to be discharged at first contact. Only 32% of children were managed in soft cast and discharged at first appointment. Net hospital earnings treating this cohort amounted to 20,146. Treating this cohort with the proposed removable soft cast pathway would earn 24,097 (19.6% increase) and would save plaster room time by 34.7%.
Conclusion: Soft casts are a cost-effective way of managing buckle fractures. Reducing inappropriate fracture clinic follow-ups can increase new patient output and improve service efficiency. Based on these findings, a new treatment algorithm using soft casts has been introduced in our department.

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