None listed
Conditions
Brief summary
The PMH physiotherapy and plastics department would like to review the current practices of how we manage children with the simpler, uncomplicated finger fractures (broken bones). We want to see if we can provide treatment in a more time efficient and cost effective way, whilst ensuring the fractures continue to heal well. These fractures tend to managed with a 3 week immobilisation in a plaster cast. Currently, after seeing the doctor and having the cast removed, families and patients may wait over two hours to see the physiotherapists for advice on exercise and a home program to help with the stiffness after the cast is taken off. This long wait to see the physiotherapy continues despite many changes made to the way we run the clinics in an attempt to decrease this wait time. Many families have complained about this long wait time. We have investigated how other children’s hospitals in Australia manage simple fractures of the hand. We found that the treatment varies between the Australian states and there is little in the medical literature that gives us guidance as to whether children have any short or long term problems if they don’t have physiotherapy after the cast is taken off. We want to determine if children with simple hand fractures are able to achieve full active movement of all the fingers and wrist with just the provision of an education and physiotherapy exercise handout alone, instead of the one-on-one hand therapy currently provided by the physiotherapist. This in turn will reduce the burden on the family to travel to PMH for unnecessary appointments and decrease the wait time for physiotherapy, as fewer children will need this service during clinic. It will also ensure the physiotherapist can safely prioritise patients with other more complicated fractures where physiotherapy is essential to improve their recovery. The outcome of this study will identify the most efficient and effective way of managing the simple finger and hand fractures. Other Australian states are interested in changing their practise based on our results.
Interventions
Following removal of their plaster cast, baseline assessments will be performed. Group 1 will then receive an educational handout from the plastics registrar that advises on how to self manage their hand now that their hand is no longer immobilised. Participants will be re-assessed at 2 weeks post.
Sponsors
Princess Margaret hospital
Study design
Allocation
Randomised controlled trial
Primary purpose
Treatment
Eligibility
Sex/Gender
All
Age
5 Years to 16 Years
Healthy volunteers
No
Inclusion criteria
Simple phalange or metacarpal fractures that are neither angulated nor displaced. Stable fractures that are mildly displaced that did not require manipulation under anaesthetic (MUA). Phalange shaft fracture with resultant axial angulations up to 10 degrees and no rotational deformity is accepted. Metacarpal neck fracture of 5 degrees to 30 degrees angulations (Bernstein and Chung 2006). Stable fractures that are displaced and requiring MUA to achieve an acceptable anatomical alignment that is maintained without requiring internal fixation.
Exclusion criteria
Displaced/angulated fracture that require MUA and requiring internal fixation Any associated soft tissue injuries e.g. Mallet, Central slip or Ulnar collateral ligament strain (UCL) Open wounds or lacerations i.e. open fractures e.g. Seymour’s fracture
Outcome results
None listed