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How to deal with broken wrists

A shift to splints?

September is here – a month when kids tend to break their wrists more than most others. A trip to the ER usually ends up with the unfortunate child garnering a heavy, new accoutrement – a cast. After 6 weeks of itchy discomfort and the sight of a scary saw used to take off the cast, said child’s almost good as new.

A new study done at the Hospital for Sick Children in Toronto has shown there may be a better way ( http://www.cmaj.ca/cgi/content/abstract/cmaj.100119v1 ). For kids with minimally angulated fractures of the distal radius, using a splint instead of a short arm cast was equally effective. The 96 5- to 12-year olds had similar range of motion, grip strength, degree of improvement, and complications at the end of therapy. However, the splint group could also remove the pre-fab splints to take a bath.

A previous study on 113 6- to 15-year olds with uncomplicated ulna buckle and/or distal radius fractures also concluded that splints were preferable for these types of fractures in children ( http://pediatrics.aappublications.org/cgi/content/full/117/3/691 ).

Right now, the Ontario healthcare system doesn’t cover the cost of prefabricated splints, but they’re cheaper than fiberglass casts and can be made out of plaster of Paris. “You can make them any size you want,” says Dr. Joe Hyndman of Halifax’s IWK Health Centre, a long-time veteran of treating kids’ fractures.

And, Dr. Kathy Boutis, an ER doc at SickKids and the study’s co-author, is confident that staff members will adopt this treatment quickly, considering her study’s results.

Most of the injured kids -- and their parents -- preferred the ease and versatility of the splints. Considering the comparable physical function the children enjoyed, which was measured by the Activities Scale for Kids (ASK) ( http://www.activitiesscaleforkids.com/ ) after their splints were removed, this shift in treatment seems like a no-brainer.
Milena Katz

3 comments:

  1. sharon ( aka Purley Quirt )Sep 10, 2010 03:41 AM
    sorry..." no brainer" is the right word for this article.....

    For years E.R. staff provided an in-house made different sizes of splints for fractures of the wrist ( made from plaster on the night shift).
    The physician simply selected the best fitting size and angle for the patient and wrapped it on.
    For a "colles" fracture the same splint needed a distinct arch and was made of metal or plastic.

    These corrective measures were considered " treatment application" and not charged seperately to the patient.

    ???????? Maybe the restructuring of the Family Health Teams will bring back the farrow-to-finish service ethic as the patient in Canada is already part of a cycle that( KEY) "already pays for absolutely every step of the process and all related personnel in the healthcare industry"

    Maybe we need an article on " reverse subsidies" for the politicos to read.
    An example of this is where the tax dollars of all citizens build the library and then memberships are sold ( thus making the client/user pay twice). Reverse subsidies is illegal in ALL of Canada.
  2. sharon ( aka Purley Quirt )Sep 10, 2010 04:23 AM
    (continued).........further impact of reverse subsidies and how they are expressed...

    Goal: EQUITY of outcomes

    to help you understand the current thrust of " EQUITY of outcomes " in a " balancing the budget" perspective here is a quote:

    'A classic example has to do with targeting social policy.
    Efficiency suggests that 'a policy targeted towards those in need will provide better value for resources invested'.
    Universal programs often provide benefits to people who do not really need them.
    (KEY) They may even constitute reverse subsidies,....... in which
    poorer taxpayers contribute funds to the benefit of those who are already better off'. '

    end of quote

    http://www.oecd.org/dataoecd/50/16/38692676.pdf ( page 9)

    Perhaps we need a " means test" for those who CAN afford to pay to be penalized....versus penalizing those who cannot pay (by default)

    In different arenas of healthcare tests/formulas for EQUITY under the disguise of EQUALITY of outcomes.......is culling the flock of services into pre-categorized value clusters ( as we speak)...i.e. new "targets"

    Let's have an article on the criteria for determining VALUE in :

    +equity

    +equality

    .....and how the blanket expectation for "all to pay" leaves some citizens in a position where they cannot/ will not seek the service at all....

    ( e.g. they cannot even afford to pay for membership in the very institutions their taxes have created ) :(
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