Elbow
A new “virtual” patient pathway for the management of radial head and neck fractures

https://doi.org/10.1016/j.jse.2013.11.006Get rights and content

Background

Minimally displaced radial head and neck fractures are common and the outcome with conservative treatment is generally excellent. A new protocol was introduced to manage patients with these suspected fractures at a major urban hospital. Simple, undisplaced fractures without other associated injuries or instability were discharged with structured advice but no further face-to-face review. Patients with more complex injuries were reviewed at a “virtual clinic.” The aim of this study was to examine the outcome of this process in terms of patient flow, satisfaction, reattendance, and reintervention.

Methods

The 202 eligible patients, who presented during a 1-year period from October 2011 to October 2012, were identified retrospectively from a prospectively collected administrative database. Mason type III and IV fractures were excluded. A questionnaire was administered by mail or phone call to assess satisfaction with the process, information received, and function.

Results

Twenty (10%) patients required face-to-face review in a clinic, whereas 182 (90%) were managed with direct discharge; 155 patients responded to the survey (77%). The overall satisfaction rate was 96% in the suspected fracture group and 87% in the definite fracture group (P = .08). Satisfaction with the information provided was 95%. Two (1%) required late surgical intervention.

Conclusion

In this study, patients with suspected Mason I or II fractures were managed with limited face-to-face follow-up with high satisfaction rates. The reintervention rate was extremely low. This process has significant benefits to patients, who have fewer hospital visits, and to orthopaedic departments, which have more time to devote to complex cases.

Section snippets

Materials and methods

This was a retrospective review of all patients managed according to the new protocol between October 2011 and October 2012. The inclusion criteria were patients with an isolated, actual or suspected, radial head fracture who presented to the ED or its associated minor injuries unit during the time period. Patients were excluded if they had suffered a Mason III injury (n = 1), complex fracture dislocation (n = 3), bilateral injury (n = 1), or another injury (n = 2) or were referred with a

Results

There were 20 patients (9.9%) who required early face-to-face review in an orthopaedic setting (Table I). Of those who responded to the survey, another 20 (13%) visited another physician, such as their general practitioner, during the follow-up period. The ED discharged 137 patients (68%) with explanation and advice. Another 45 patients (22%) were discharged after discussion at the VFC. There was no difference in the proportion of those discharged without review between suspected and definite

Discussion

This study shows that acceptable patient satisfaction can be achieved by following our protocol. Only 10% of included patients required face-to-face review. The dissatisfaction rate was in keeping with the reported literature and similar to what would have been achieved with traditional universal fracture clinic review.6 There were no significant differences in review rates or overall satisfaction between suspected and definite fractures. There was no difference in satisfaction between Mason II

Conclusions

This study presents evidence that simple, stable fractures of the radial head with well-understood natural histories can be safely and effectively treated with minimal intervention. In particular, this study showed no difference in satisfaction between suspected, Mason I, and Mason II fractures. This approach is beneficial to patients as well as reducing the burden of unnecessary review in orthopaedic departments. This protocol for the “self-care” of radial head fractures offers an attractive

Acknowledgments

Department of Emergency Medicine, Glasgow Royal Infirmary, and nursing staff, Fracture Clinic, Department of Orthopaedic Surgery, Glasgow Royal Infirmary.

Disclaimer

The authors, their immediate families, and any research foundation with which they are affiliated did not receive any financial payments or other benefits from any commercial entity related to the subject of this article.

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