Abstract：
OBJECTIVE: 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 clavicle, proximal humerus, humeral shaft, olecranon, radial shaft and distal radius.
METHODS: This was a retrospective cohort 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-week outpatient visit. Abnormalities were defined as all differences between the intra-operative (or direct postoperative) and 6-week x-ray. In 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-week outpatient visit as a whole. Deviations were also categorized into either requiring additional diagnostics, additional interventions, change of standard postoperative immobilization, weightbearing or allowed range of motion.
RESULTS: A total of 267 patients were included. Abnormalities on x-ray at 6 weeks postoperatively 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-week 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.
CONCLUSIONS: The routine 6-week 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.
METHODS: Level IV; Case Series; Prognosis Study.
METHODS: This was a retrospective cohort 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-week outpatient visit. Abnormalities were defined as all differences between the intra-operative (or direct postoperative) and 6-week x-ray. In 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-week outpatient visit as a whole. Deviations were also categorized into either requiring additional diagnostics, additional interventions, change of standard postoperative immobilization, weightbearing or allowed range of motion.
RESULTS: A total of 267 patients were included. Abnormalities on x-ray at 6 weeks postoperatively 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-week 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.
CONCLUSIONS: The routine 6-week 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.
METHODS: Level IV; Case Series; Prognosis Study.
摘要：
目的：探讨常规计划的为期六周的门诊就诊和X线检查对手术治疗包括锁骨在内的最常见上肢骨折患者的有用性。肱骨近端,肱骨轴,鹰嘴,径向轴和桡骨远端。
方法：这是一项回顾性队列研究，对2019年至2022年间在1级创伤中心接受手术治疗最常见上肢骨折的所有患者进行了研究。感兴趣的第一个结果是在6周门诊就诊时在X射线上发现的异常发生率。异常定义为术中（或直接术后）和6周X射线之间的所有差异。如果检测到异常，对医院记录进行了筛查，以确定其临床后果。临床后果被分类为需要额外的诊断，额外的干预措施，标准术后固定的变化，承重或允许的运动范围（ROM）。感兴趣的第二个结果是基于整个6周的门诊就诊，偏离当地标准术后治疗和随访方案的发生率。偏差也被分类为需要额外诊断，额外的干预措施，标准术后固定的变化，负重或允许的运动范围。
结果：共纳入267例患者。术后6周仅有10例（3.7％）患者发现X射线异常，其中只有4例（1.5％）具有临床意义（在三名患者中，需要额外的影像学检查，在一名患者中，有必要偏离标准的负重/ROM限制方案）。在6周的门诊就诊期间的临床/放射学发现仅导致8名（3.0％）患者偏离标准。值得注意的是,这些患者中的大多数出现了提示并发症的症状.
结论：常规的6周门诊就诊和X线检查，常见上肢骨折手术后，很少有临床后果。应该质疑这些例行访问是否必要，是否应该考虑采取更有选择性的方法。
方法：IV级；病例系列；预后研究。
方法：这是一项回顾性队列研究，对2019年至2022年间在1级创伤中心接受手术治疗最常见上肢骨折的所有患者进行了研究。感兴趣的第一个结果是在6周门诊就诊时在X射线上发现的异常发生率。异常定义为术中（或直接术后）和6周X射线之间的所有差异。如果检测到异常，对医院记录进行了筛查，以确定其临床后果。临床后果被分类为需要额外的诊断，额外的干预措施，标准术后固定的变化，承重或允许的运动范围（ROM）。感兴趣的第二个结果是基于整个6周的门诊就诊，偏离当地标准术后治疗和随访方案的发生率。偏差也被分类为需要额外诊断，额外的干预措施，标准术后固定的变化，负重或允许的运动范围。
结果：共纳入267例患者。术后6周仅有10例（3.7％）患者发现X射线异常，其中只有4例（1.5％）具有临床意义（在三名患者中，需要额外的影像学检查，在一名患者中，有必要偏离标准的负重/ROM限制方案）。在6周的门诊就诊期间的临床/放射学发现仅导致8名（3.0％）患者偏离标准。值得注意的是,这些患者中的大多数出现了提示并发症的症状.
结论：常规的6周门诊就诊和X线检查，常见上肢骨折手术后，很少有临床后果。应该质疑这些例行访问是否必要，是否应该考虑采取更有选择性的方法。
方法：IV级；病例系列；预后研究。
