2607 Management of paediatric elbow injuries, where’s the equipoise? A UK & Ireland wide international survey of practice

<h3>Aims and Objectives</h3> Limited national guidance exists in the UK and Ireland for supracondylar fracture management, the second most common childhood fracture, with a recent systematic review highlighting low quality evidence for the management of Gartland 1 fractures. We sought to ascertain the extent of practice variation for elbow injuries across the Paediatric Emergency Research in the United Kingdom &amp; Ireland (PERUKI) network to determine whether future research is required to inform practice. <h3>Method and Design</h3> An online REDCap survey was circulated to fifty-five participating PERUKI sites between 24/05/2023 – 27/06/2023 containing questions around management/intervention/follow up on progressively severe elbow injury radiographs (normal to Gartland 3). A single response was requested per site with clear instructions within the survey and via PERUKI, an established research network, with site leads experienced in group-response surveys. Images were sourced from Radiopaedia.org and boneschool.com with a description of findings alongside each image to mitigate misinterpretation. <h3>Results and Conclusion</h3> 45/55 (82%) sites provided responses with 4/45 partial responses due to specialty engagement challenges. Gartland 2 with coronal displacement and Gartland 3 fractures showed uniform agreement on management but all other images showed variation. 80% of sites would immobilise (sling or rigid immobilisation) a radiograph without an apparent fracture, 79% would rigidly immobilise Gartland 1 injuries and one third of sites would non-surgically manage Gartland 2 without coronal displacement injuries. Conclusion - A UK &amp; Ireland wide survey has demonstrated marked variation in the management of Gartland 1 and 2 type injuries. Combined with the paucity of existing evidence, the multiple areas of equipoise identified highlight the need for future high-quality research to improve the care of these common childhood injuries.