ElbowA new “virtual” patient pathway for the management of radial head and neck fractures
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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Adoption of direct discharge of simple stable injuries amongst (orthopaedic) trauma surgeons
2021, InjuryCitation Excerpt :The second section contained eleven cases describing the hypothetical presentation of a patient with an injury to the ED of the responding surgeon (Table 1). The selection of these injuries was based on previous studies that illustrated direct discharge of these injuries is an effective and safe alternative to ‘standard care’ with follow-up. [1,3,7,8,13–15,18–20] An embedded DICOM viewer allowed respondents to review high-quality standard radiographic projections of each injury, comparable to daily practice.
No ethical or review board approval was required for this study.