REGIONAL MANAGEMENT OF FEMORAL SHAFT FRACTURES IN UNDER-5S IN THE NORTH WEST

Aim To establish current management of femoral shaft fractures and establish a regional pathway to improve management. Introduction There is currently no established pathway for the management of femoral shaft fractures in the North West and they can be a tricky case for the on call team to manage at DGHs. Method An analysis of TARN data from 2018-2022 looking at femoral shaft fractures from in children was analysed and compared to ONS data. A qualitative survey was sent out to every hospital in the North West establishing the capabilities of each hospital in managing these fractures. Results There are approximately 50 femoral shaft fractures/year in the North West. The average length of stay was 9.6 days (2.7 – 22 days), more than double the national average of 4 days. There were 101 responses to the survey. Most hospital are unable to anaesthetise under 3s, apply a Thomas splint out of hours, apply a hip spica or have appropriate physiotherapy/OT support to manage these children. The average rating respondents gave for their own management of these fractures was 4.5/5 at Tertiary children's hospitals vs 2.8/5 at DGHs. Conclusions A new pathway to centralise management could lead to safe, seamless ED to ED transfers with a Thomas splint applied before application of a hip spica to reduce the LoS, reduce delays to treatment and improve the children's journey as well as taking the burden off non-specialist hospitals.