Pediatric Distal Radius Fracture Reduction and Casting: The Effect of Simulation on Costs and Care
Summary: Distal radius fractures occur in approximately 1 in 100 children per year, and the standard of care remains closed reduction and cast immobilization. Suboptimal reduction and casting may result in loss of reduction, physical impairment, cast saw injury, and need for subsequent surgical intervention. The purpose of this investigation is to determine: 1) how much simulation training is needed to improve clinical results, and 2) are the decreases in patient care costs justify the costs of the simulation curriculum. All PGY-3 orthopaedic surgery residents rotating through Boston Children’s Hospital will be enrolled in a novel simulation training program. Trainees will be randomized to different frequencies of simulation training, and performance will be assessed using validated OSATS. Each trainee’s clinical performance will also be measured using cast indices, loss of reduction rates, and cast saw injuries. Correlations will be made between simulation performance and clinical results. Finally, using existing clinical databases and process, maps, time-derived activity-based costing (TDABC) analysis will be performed to determine the cost-effectiveness of this simulation program.