Journal of orthopaedic trauma · 2015
Minimally displaced radial head/neck fractures (Mason type-I, OTA types 21A2.2 and 21B2.1): are we "over treating" our patients?
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Shulman Brandon S, Lee James H, Liporace Frank A, Egol Kenneth A
Аннотация
OBJECTIVE: The purpose of this study was to investigate the nonoperative treatment strategies for Mason-Johnson type-I radial head fractures.
DESIGN AND SETTING: Retrospective review of every patient with a closed radial head/neck fracture who presented to our tertiary care specialty institution in the past 2 years.
PATIENTS/PARTICIPANTS: A search of ICD-9 code 813.05, closed fracture of the radial head/neck, in our electronic record system yielded 82 consecutive patients.
MAIN OUTCOME MEASUREMENTS: Complications and treatment interventions were recorded. Demographic, radiographic, and physical examination data were collected for all patients treated nonoperatively and analyzed for association with recommendation for continued follow-up and radiographic assessment.
RESULTS: Fifty-four patients (68%) had 56 nondisplaced or minimally displaced (<2 mm) radial head or neck fractures without an additional injury to the affected limb. All patients were treated nonoperatively, and no patient in this cohort developed a complication or had any medical or surgical intervention other than physical therapy. No radiographic or physical examination measure was significantly associated with recommendation for the second outpatient follow-up, third outpatient follow-up, or with the number of additional radiographs ordered beyond the initial examination. An average of 4.4 (SD, 3.3) additional x-rays were taken of each affected elbow after initial outpatient presentation.
CONCLUSIONS: Orthopaedic surgeons are likely over treating patients with Mason-Johnson type-I radial head fractures by recommending frequent radiographic follow-up without modifying treatment, leading to unnecessary patient visits, radiation exposure, and increased costs.
LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
DESIGN AND SETTING: Retrospective review of every patient with a closed radial head/neck fracture who presented to our tertiary care specialty institution in the past 2 years.
PATIENTS/PARTICIPANTS: A search of ICD-9 code 813.05, closed fracture of the radial head/neck, in our electronic record system yielded 82 consecutive patients.
MAIN OUTCOME MEASUREMENTS: Complications and treatment interventions were recorded. Demographic, radiographic, and physical examination data were collected for all patients treated nonoperatively and analyzed for association with recommendation for continued follow-up and radiographic assessment.
RESULTS: Fifty-four patients (68%) had 56 nondisplaced or minimally displaced (<2 mm) radial head or neck fractures without an additional injury to the affected limb. All patients were treated nonoperatively, and no patient in this cohort developed a complication or had any medical or surgical intervention other than physical therapy. No radiographic or physical examination measure was significantly associated with recommendation for the second outpatient follow-up, third outpatient follow-up, or with the number of additional radiographs ordered beyond the initial examination. An average of 4.4 (SD, 3.3) additional x-rays were taken of each affected elbow after initial outpatient presentation.
CONCLUSIONS: Orthopaedic surgeons are likely over treating patients with Mason-Johnson type-I radial head fractures by recommending frequent radiographic follow-up without modifying treatment, leading to unnecessary patient visits, radiation exposure, and increased costs.
LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.