A qualitative study of parents’ and their child’s experience of a medial epicondyle fracture and what they think about the treatment options

Journal article

Aims
The aim of this study was to explore parents and young people’s experience of having a medial epicondyle fracture, and their thoughts about the uncertainty regarding the optimal treatment.
Methods
Families were identified after being invited to participate in a randomized controlled trial of surgery or no surgery for displaced medial epicondyle fractures of the humerus in children. A purposeful sample of 25 parents (22 females) and five young people (three females, mean age 11 years (7 to 14)) from 15 UK hospitals were interviewed a mean of 39 days (14 to 78) from injury. Qualitative interviews were informed by phenomenology and themes identified to convey participants’ experience.
Results
The results identify parents’ desire to do the best for their child expressed through two themes: 1) ‘uncertainty’ (being uncertain about the best treatment option); and 2) ‘facilitating recovery’ (sharing the experience). Parents and young people were shocked when confronted with uncertainty about treatment and they felt responsible for the decision. They searched for further information, drew on their own experience, and struggled to weigh up risks of the treatments. Discussion with surgeons provided crucial support for decision-making, and young people were involved to a varying degree. In facilitating recovery, parents balanced increasing activity with protecting their child, but lacked knowledge about pain management, and how to improve strength and function of the arm. They hoped for a return to normal, including competitive sports.
Conclusion
Surgeons are aware of the impact of injury on children and their parents; however, they may be less aware of the turmoil created by treatment uncertainty. Confident surgeons who appreciate and contextualize the importance of pre-existing experience and beliefs are best placed to help the family develop confidence to embrace uncertainty, particularly regarding participation in clinical trials.

Authors: Papiez, K; Tutton, E; Phelps, E; Costa, M; Achten, J

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Bone and Joint Publishing
• Journal: Bone and Joint Open
• Volume: 2
• Issue: 6
• Pages: 359–364
• Publication date: 2021-06-03
• Acceptance date: 2021-02-05
• DOI: 10.1302/2633-1462.26.BJO-2020-0186.R1
• EISSN: 2633-1462
• Language: English
• Keywords: FFR; interviews; trauma; paediatrics; medial epicondyle fracture; qualitative research