What Caregivers Want - Immobilization Preferences For Pediatric Buckle Fractures

Background: Caregiver preferences represent one potential barrier to the uptake of 'minimalist', splint-based strategies in the management of pediatric buckle fractures of the wrist as opposed to traditional casting. This study sought to examine caregiver treatment preferences and factors of influence in the management of this injury. We hypothesized that caregivers would prefer cast immobilization. Methods: A 22-item caregiver survey was created to assess demographics, treatment preferences and influential factors. Caregivers were also presented with information regarding the equivalent outcomes of available treatment options. The survey was completed by a convenience sample of caregivers presenting with patients of any diagnosis to our Pediatric Orthopaedic Clinic. Results: A total of 297 surveys were obtained from unique respondents who were predominantly mothers (81.2%) caring for 2.4 (SD 1.3) children. Forty-one percent had previously cared for a child with a fracture. Caregivers accompanied patients who were 9.0+/-5.0-years-old, 34% of whom were actively being treated for an orthopaedic injury. Caregiver immobilization preferences for buckle fractures of the wrist were: no preference (43.1%), cast (32.3%) and splint (24.6%). The doctor's recommendation was the most influential factor on this decision while the child's gender was the least of the factors assessed. Those who rated treatment durability and child's activity level higher were associated with a preference for casting, while those who rated comfort higher were associated with a preference for splinting. There were no other significant factor variables associated with treatment preferences. Conclusions: This study is the first to characterize caregiver preferences regarding immobilization devices in the realm of buckle fractures of the wrist. Findings identified that preferences are mixed, with the interest in casting being less than anticipated. Factors influencing caregiver preference include the doctor's recommendation, durability, the patient's activity level, and comfort. This knowledge can be utilized by providers who are seeking to implement a splint-based immobilization strategy for buckle fractures as they approach the treatment discussion and plan.