Paediatric Femoral Fracture Transfer Guideline
Flowchart
Introduction, Scope & Purpose
The aim of this document is to guide nursing and medical staff, using a standardised tool, in the safe transfer of paediatric patients who have sustained a fractured femur. The document will set out all of the relevant criteria to ensure a patient is given optimum pain relief, has relevant imaging and is ultimately transferred safely.

The incidence of a paediatric femoral fracture is 5.82 per 100,000 children aged 0-16 (Talbot, 2018). Whilst the incidence seems low, paediatric femoral fractures are the most common musculoskeletal injury that results in hospitalisation (Baldwin et al, 2010).

This guideline has been developed to assist all staff involved in the immediate pre-hospital transfer of a paediatric patient who has sustained a fractured femur.

The aim of this guideline is to achieve best practice, ensuring that any child with a fractured femur is transferred to University Hospitals Southampton (UHS) in line with standard practice. This will eliminate any insufficiencies in care e.g. inadequate analgesia and inappropriate fracture management.
Definitions​
Thomas Splint
A type of traction used to immobilise and position fractures of the femur (RCN 2015).

Gallows Traction
Traction used in young children with a fractured shaft of femur (RCN 2015).

BOA
British Orthopaedic Association (2021)

BOAST
BOA Standards for Trauma and Orthopaedics (2021)
Guideline
The implementation of standardised care will have inevitable barriers, e.g. equipment, funding and level of training at District General Hospitals (DGH’s). With all hospitals in the local area using the same equipment, the issue of hospitals not getting their equipment back will be eliminated. It is expected that the initial expenditure for new equipment will only be required once, as the splints are reusable and durable.

Safeguarding – It is expected that the referring hospital will initiate the process when safeguarding concerns have arisen regarding the mechanism of injury. This is so that the appropriate local authorities are involved from the beginning of any case which allows for smoother transition when implementing community-led discharge plans.
Communication & Training Plans
As UHS is introducing this new policy, we will be fully prepared to offer training to the Trusts that implement our policy until they are fully competent. We would recommend that each Trust nominates a Trust Lead for traction who will be responsible for the dissemination of information within their ward areas. UHS will be prepared to run refreshers when required or if there is a national traction update.
Process for Monitoring Compliance
It is widely recognised that reduced variation in practice improves patient care and outcomes. When staff are confident that a structured and standardised method of care is in place, there is less opportunity for human error resulting in an environment that supports and fosters quality patient care.

The effectiveness of this flowchart will be monitored and analysed through the use of auditing. Patients pain score and effectiveness of their traction will be gauged on arrival to UHS and compared to the same outcomes pre-introduction of this intervention.
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The purpose of monitoring is to provide assurance that the agreed approach is being followed. This ensures that we get things right for patients, use resources well and protect our reputation. Our monitoring will therefore be proportionate, achievable and deal with specifics that can be assessed or measured.
References​
  • ​Talbot, C et al (2018) Fractures of the Femoral Shaft in Children: National Epidemiology and Treatment Trends in England Following Activation of Major Trauma Networks The Bone and Joint Journal 100-B(1):109-118
  • Baldwin, K et al (2010) Femur Fractures in the Pediatric Population: Abuse or Accidental Trauma? Clinical Orthopaedics and Related Research 469(3):798-80
Document Version: 
1.0

Lead Authors: 
Katie Watts, Paediatric Orthopaedic Nurse Specialist, UHS
Matthew Barry, Paediatric Orthopaedic Consultant, UHS
Approving Network:
Wessex Paediatric Orthopaedic Network

Date of Approval: 
November 2021

Review Due:
November 2024