Environmental Impact of Overtreatment of Distal Radius Buckle Fractures

Résumé fourni par la source

Introduction: Pediatric buckle fractures are common. Current literature supports a single provider visit with education and removable wrist brace/bandage, without additional follow-up visits. Potential overtreatment through casting and follow-up visits may impose a substantial environmental burden through waste generated from casts and vehicular CO 2 emission. This study seeks to estimate the national environmental impact of buckle fracture overtreatment through geospatial analysis extrapolated from a review of buckle fracture treatment at our institution. Methods: A retrospective chart review was performed to determine incidence and treatment of buckle fractures at our institution between 2018 and 2022. All radiographs were reviewed to confirm appropriateness for inclusion. Data were collected for treatment, follow-up frequency, cast utilization, and patient home ZIP code. Buckle fracture incidence was computed using the total pediatric population served by our institution, derived from United States (US) Census data. Treatment was assumed to occur at the office of the nearest orthopedic surgeon, identified through the National Provider Identifier Registry. For cast waste estimation, we collected and weighed discarded short-arm casts from our institution and used the number of patients treated in a cast to estimate total waste. CO 2 emissions were estimated to be 411 g of CO 2 per mile, and mileage was calculated for round-trip distance to the nearest orthopedic surgeon and multiplied by the estimated number of unnecessary visits. Travel for the initial visit was not considered overtreatment and was not included. Results: Annually, the United States sees an estimated 66,495 buckle fractures, with 62.5% overtreated with casting. The average short-arm cast weighed 0.498 lbs ± 0.133. When additional visits occurred, there were an average of 1.2 additional visits. Each year, overtreatment of pediatric buckle fractures in the United States generates an estimated 9.4 tons of cast waste and 405.4 tons of CO 2 . Conclusion: Overtreatment of buckle fractures has a significant measurable environmental impact.

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