Deferred Surgical Treatment of Upper Limb Trauma in a Pandemic Context
Keywords:
Arm Injuries/surgery, Arm Injuries/therapy, COVID‐19, Fracture Fixation/methods, Orthopedic Procedures, Pain Management, Pandemics, Radius Fractures, Time Factors, Time‐to‐TreatmentAbstract
Introduction: In order to manage the high number of patients with upper limb fractures that require surgical treat‐ ment, it is essential to have a well‐defined structure, in order to promote an adequate response to each type of orthope‐ dic pathology and to fit the reality of all other pathologies. In order to reduce hospital stays and promote better treat‐ ment of patients, our service promoted the deferred treatment of numerous pathologies in the area of traumatology. The aim of the study was to assess the type of pathologies, patient characteristics, degree of satisfaction and pain con‐ trol of patients with upper limb fractures, treated in a deferred manner in our hospital, in 2020, a severely marked year by the global pandemic context by COVID‐19.
Methods: We developed a retrospective observational study with the evaluation of 71 patients treated in a deferred manner and who waited at their home for a call for surgical treatment.
Results: We recorded an average age of 49 years (14‐71), with 40 males (56.3%). The most frequent diagnoses were distal radius fracture (36.6%; n=26), metacarpal fracture (19.7%, n=14) and phalangeal fractures (11.3%, n=8). The average time from coming to the emergency department until definitive surgical treatment was 7 days and the most frequent anesthetic risk was ASA 2 (in 64.6%). After a telephone call made in May 2021, it was possible to assess 36 of the 65 patients operated, with 89% reporting satisfaction with the possibility of waiting for surgical treatment at home and 92% reporting recommending this type of strategy. About pain control at home, while waiting for surgery, applying the VAS score: the mean was 1.94 (0 – 9). We applied the score (QuickDASH) to all patients with distal radius fractures included in the group, with a mean of 18.2 points (0 – 65.9; SD 18.65).
Conclusion: Deferred treatment of upper limb traumatic pathology was satisfactory for patients, who recommended the treatment and allowed pain control throughout the clinical course.
Downloads
References
Schmidt AH, Anglen JO, Nana AD, Varecka TF. Adult trauma: getting through the night. Instr Course Lect. 2010;59:437‐53.
Crist BD, Ferguson T, Murtha YM, Lee MA. Surgical timing of treating injured extremities: an evolving concept of urgency. Instr Course Lect. 2013;62:17‐28.
Cashman JP, Guerin SM, Hemsing M, McCormack D. Effect of deferred treatment of supracondylar humeral fractures. Surgeon. 2010;8:71‐3. doi: 10.1016/j.surge.2009.10.011.
Yiğit Ş. What should be the timing of surgical treatment of humeral shaft fractures? Medicine. 2020;99:e19858. doi: 10.1097/ MD.0000000000019858.
Randau TM, Jaenisch M, Haffer H, Schömig F, Kasapovic A, Olejniczak K, et al. Collateral effect of COVID‐19 on orthopedic and trauma surgery. PLoS One. 2020;15:e0238759. doi: 10.1371/journal. pone.0238759.
Direção Geral da Saúde. Rede Nacional de Especialidade Hospitalar e de Referenciação: Ortopedia. Lisboa: DGS;2018.
Gummesson C, Atroshi I, Ekdahl C. The disabilities of the arm, shoulder and hand (DASH) outcome questionnaire: longitudinal construct validity and measuring self‐rated health change after surgery. BMC Musculoskelet Disord. ;4:11. doi: 10.1186/1471‐2474‐4‐11.
Tsang P, Walton D, Grewal R, MacDermid J. Validation of the Quick‐DASH and DASH in Patients With Distal Radius Fractures Through Agreement Analysis. Arch Phys Med Rehabil. 2017;98:1217‐22.e1. doi: 10.1016/j.apmr.2016.11.023.
Tornetta P, Ricci W, Court‐Brown CM, McQueen MM, McKee M, editors. Rockwood and Green’s Fractures in Adults Add to Wish List Rock‐ wood and Green’s Fractures in Adults. Alphen aan den Rijn: Wolters Kluwer; 2019.
Tang JB. Distal radius fracture: diagnosis, treatment, and controversies. Clin Plast Surg. 2014;41:481‐99. doi: 10.1016/j.cps.2014.04.001.
Marian AA, Bayman EO, Gillett A, Hadder B, Todd MM. The influence of the type and design of the anesthesia record on ASA physical status scores in surgical patients: paper records vs. electronic anesthesia records. BMC Med Inform Decis Mak. 2016;16:29. doi: 10.1186/ s12911‐016‐0267‐6.
Ochen Y, Peek J, van der Velde D, Beeres FJ, van Heijl M, Groenwold RH, et al. Operative vs Nonoperative Treatment of Distal Radius Fractures in Adults: A Systematic Review and Meta‐analysis. JAMA Netw Open. 2020;3:e203497. doi: 10.1001/jamanetworkopen.2020.3497.
Kasapinova K, Kamiloski V. Outcomes of surgically treated distal radius fractures associated with triangular fibrocartilage complex injury. J Hand Ther. 2020;33:339‐45. doi: 10.1016/j.jht.2017.09.012. .
Entidade Reguladora da Saúde. Relatório ERS: Portugal em 2014. Lisboa: ERS; 2015.
Published
Issue
Section
License
Copyright (c) 2023 Orthopaedic SPOT
This work is licensed under a Creative Commons Attribution 4.0 International License.
