Bryan van de Wall (Lucerne / CH), Thomas Bosch (Leiden / NL), Felix Peuker (Utrecht / NL), Bjorn Link (Lucerne / CH), Reto Babst (Lucerne / CH), Nicole van Veelen (Lucerne / CH), Frank Beeres (Lucerne / CH)
Objectives:
To investigate the usefulness of the routinely planned six week outpatient visit and X-ray in patients treated surgically for the most common upper extremity fractures including clavicula, proximal humerus, humerus shaft, olecranon, radial shaft and distal radius.
Method:
This was a retrospective snapshot study of all patients treated surgically for the most common upper extremity fractures between 2019 and 2022 in a level 1 trauma center. The first outcome of interest was the incidence of abnormalities found on the X-ray made at the 6-weeks outpatient visitIn case an abnormality was detected, the hospital records were screened to determine its clinical consequence. The clinical consequences were categorized into requiring either additional diagnostics, additional interventions, change of standard postoperative immobilization, weightbearing or allowed range of motion (ROM). The second outcome of interest was the incidence of deviations from the local standard post operative treatment and follow-up protocol based on the 6-weeks outpatient visit as a whole. Deviations were also categorized in the same manner.
Results
A total of 267 patients were included. Abnormalities on X-ray at 6-weeks were found in only 10 (3.7%) patients of which only 4 (1.5%) had clinical implications (in three patients extra imaging was required and in one patient it was necessary to deviate from standard weightbearing/ROM limitation regime). The clinical/radiological findings during the 6-weeks outpatient visit led to a deviation from standard in only 8 (3.0%) patients. Notably, the majority of these patients experienced symptoms suggestive for complications.
Conclusion
The routine 6-weeks outpatient visit and X-ray, after surgery for common upper extremity fractures, rarely has clinical consequences. It should be questioned whether these routine visits are necessary and whether a more selective approach should be considered.
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