Abstracts Posters SICOT-SOF meeting Gothenburg 2010 _2_

Poster
Topic: Trauma - Systemic
Abstract number: 26269
THE EFFICACY OF INITIAL FRACTURE MANAGEMENT IN A LARGE
ORTHOPAEDIC TRAUMA UNIT
Saqib JAVED, George MCLAUCHLAN
Royal Preston Hospital, Preston (UNITED KINGDOM)
Introduction: Outpatient fracture care is dealt with by Accident and Emergency (A&E)
and orthopaedics utilising A&E and fracture clinics. Current working time directive
legislation has led to the use of more nurse practitioners instead of junior doctors in
the initial assessment and management of these cases in A&E. We analysed the
efficacy of this process.Methods: A retrospective patient note analysis was
conducted for referrals to the fracture clinic of a large trauma hospital over a four
week period. Information collected included A&E diagnosis and initial treatment,
orthopaedic diagnosis, time from injury to appointment and appropriateness of
fracture clinic referral. All referrals were evaluated by an orthopaedic
consultant.Results: 400 referrals were identified (216 male, 184 female) over a four
week period. The average age was 33 years (range 4 - 93). For only 12% of referrals
was an orthopaedic opinion sought prior to referral. The majority (75%) of patients
referred to fracture clinic were seen either by nurse practitioners or junior doctors.
Fracture clinic referrals were skewed by region with 50% of referrals being made for
hand and wrist injuries. Fifty per cent of fracture clinic referrals could have been
managed between A&E and primary care. Conclusion: The management of
musculoskeletal trauma remains suboptimal with inefficient use of orthopaedic
services. The patient load could potentially be halved with further training of frontline
A&E staff and timely orthopaedic input with targeted training of common hand, wrist,
foot and ankle injuries taking precedence.
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