Burton Kyle R, Mellema Jos J, Menendez Mariano E, Ring David, Chen Neal C
Hand and Upper Extremity Service, Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX, USA.
J Shoulder Elbow Surg. 2016 Aug;25(8):1216-22. doi: 10.1016/j.jse.2016.03.007. Epub 2016 Jun 6.
After diagnosis of an isolated radial head or neck fracture and selection of nonoperative treatment, the value of subsequent radiographs is uncertain. This study tested the null hypothesis that there are no patient, surgeon, or injury factors associated with alteration in patient management based on subsequent radiographs. Secondarily, we tested the null hypothesis that the use of subsequent radiographs is not associated with patient, surgeon, and fracture characteristics.
We identified 415 adult patients with nonoperative treatment for isolated Broberg and Morrey modified Mason type 1 or 2 fractures at a large urban hospital system during years 2013 and 2014. Patient demographics, fracture characteristics, provider characteristics, and treatment details were obtained from a hospital database. Bivariate analysis and multivariable logistic regression modeling were performed.
One of 255 patients with 262 fractures that had subsequent radiographs (0.4%) was offered surgery but declined. In multivariable analysis, displaced fractures were more likely to have subsequent radiographs, but surgeon-to-surgeon variation was a far more influential factor.
Radiographs subsequent to diagnosis do not alter treatment of radial head fractures with no associated ligament injuries or fractures. The substantial surgeon-to-surgeon variation in the use of subsequent radiographs suggests that this may be a good focus for quality improvement initiatives.
在诊断为单纯桡骨头或桡骨颈骨折并选择非手术治疗后，后续X线片的价值尚不确定。本研究检验了零假设，即不存在基于后续X线片而导致患者治疗管理改变的患者、外科医生或损伤因素。其次，我们检验了零假设，即使用后续X线片与患者、外科医生及骨折特征无关。
我们在一家大型城市医院系统中，确定了2013年和2014年接受非手术治疗的415例成年单纯Broberg和Morrey改良Mason 1型或2型骨折患者。患者人口统计学资料、骨折特征、医疗服务提供者特征及治疗细节均从医院数据库中获取。进行了双变量分析和多变量逻辑回归建模。
255例有262处骨折且进行了后续X线片检查的患者中，有1例（0.4%）被建议手术但拒绝了。在多变量分析中，移位骨折更有可能进行后续X线片检查，但外科医生之间的差异是一个更具影响力的因素。
诊断后的X线片不会改变无相关韧带损伤或骨折的桡骨头骨折的治疗。后续X线片使用上外科医生之间的显著差异表明，这可能是质量改进措施的一个良好关注点。
