Department of Orthopaedics and Trauma, Ganga Medical Centre & Hospitals Pvt. Ltd, 313, Mettupalayam road, Coimbatore, Tamil Nadu, India.
Eur J Trauma Emerg Surg. 2021 Oct;47(5):1599-1605. doi: 10.1007/s00068-020-01317-0. Epub 2020 Feb 12.
In high volume centres, audits are essential to ensure good surgical techniques and fracture fixations to avoid complications, revision surgeries and poor outcomes. A method to assess fixations for fractures of different regions employing different implants and surgical demands is a challenge. We present here a simple method of review and follow-up work flow of more than 6000 fixations every year that helped in improving outcomes and also provide training for residents and junior staff.
The results of 6348 fracture fixations in 2014, led to a trauma review system in January 2015 to classify all fracture fixations by senior consultants into three categories: category A (good fixations); category B (acceptable fixations; need further follow-up); category C (poor/unacceptable fixations needing revision) combined with a teaching program. A strategy was evolved that included the following practices: (1) identifying 'red flag' fractures that led to frequent failures, (2) routine senior surgeons' involvement in such fractures, (3) evolving 'intra-operative checklists', (4) requirement of senior surgeons' intervention if there was a 'fiddle time' of more than 20 min, and (5) approval of post-fixation c-arm image by a senior person before closure. The impact of these rules on the fixations for 2015, 2016 and 2017 were prospectively analysed.
In the years 2015, 2016 and 2017 the number of fracture fixations performed were 6579, 6978 and 7012, respectively. There was a significant increase (p < 0.001) in the number of category A fixations (87.7%, 94.6% and 96.3% in 2015, 2016 and 2017, respectively) and also a decrease in the number of category C fixations (2.23%, 0.7% and 0.2% in 2015, 2016 and 2017, respectively). The quality of fixations of the 'red flag' fractures also improved.
We present here a very effective, tested, simple and easily reproducible method of audit and follow-up work flow that can be used in all high turnover trauma centres to improve outcomes and can also serve as a teaching resource for junior staff.
Prospective study.
Level II.
在高容量中心，审核对于确保良好的手术技术和骨折固定至关重要，以避免并发症、翻修手术和不良结果。评估不同区域、使用不同植入物和不同手术需求的骨折固定的方法是一个挑战。我们在此介绍一种简单的方法，用于回顾和跟踪每年超过 6000 次的固定，这有助于改善结果，并为住院医师和初级工作人员提供培训。
2014 年 6348 例骨折固定的结果导致 2015 年 1 月建立了创伤审查系统，将所有骨折固定由高级顾问分为三类：A 类（良好固定）；B 类（可接受固定；需要进一步随访）；C 类（不良/不可接受的需要翻修的固定），同时制定了教学计划。制定了一项策略，包括以下做法：（1）识别导致频繁失败的“红旗”骨折；（2）让高级外科医生经常参与此类骨折；（3）制定“术中检查表”；（4）如果“摆弄时间”超过 20 分钟，则需要高级外科医生的干预；（5）在关闭前，由高级人员批准固定后的 C 臂图像。前瞻性分析这些规则对 2015 年、2016 年和 2017 年固定的影响。
在 2015 年、2016 年和 2017 年，进行的骨折固定数量分别为 6579、6978 和 7012。A 类固定的数量显著增加（p<0.001）（2015 年、2016 年和 2017 年分别为 87.7%、94.6%和 96.3%），C 类固定的数量也减少（2015 年、2016 年和 2017 年分别为 2.23%、0.7%和 0.2%）。“红旗”骨折的固定质量也得到了改善。
我们在此介绍一种非常有效、经过验证、简单且易于复制的审核和随访工作流程方法，可用于所有高周转率创伤中心，以改善结果，并可作为初级工作人员的教学资源。
前瞻性研究。
二级。
