Emergency Medicine, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
Emergency Medicine, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK.
Emerg Med J. 2020 Aug;37(8):498-501. doi: 10.1136/emermed-2020-209478. Epub 2020 Jul 3.
Colles' type fractures of the distal radius are one of the most commonly manipulated fractures in the ED. Local audit data suggest that a high proportion of these injuries undergo subsequent surgical fixation. If widespread, this could represent a potential burden on patients and the NHS worthy of further research. The aims of this study were to estimate the rate of surgical fixation of Colles' type distal radial fractures after ED fracture manipulation and explore variations in their management in UK EDs.
We conducted a multicentre observational study in 16 EDs in the UK from 4 February 2019 to 31 March 2019. All adult patients with a Colles' fracture who underwent fracture manipulation in the ED were included. Patients who could not be followed up and those with volar displaced fractures were excluded. We measured the rate of wrist fracture surgery at 6 weeks, patient demographics and variations in anaesthetic technique used.
During the study period, 328 adult patients attended the participating EDs with a distal radial fracture. Of these, 83 patients underwent fracture manipulation in the ED and were eligible for the study. Their mean age (SD) was 65.3 (17.0) years, 84.3% were female and the most common method of anaesthesia used was haematoma block (38.6%). 34 (41.0%, 95 % CI 30.3 to 52.3) patients had subsequent surgical fixation of their fracture. Younger age was associated with higher rates of surgical fixation but ED anaesthetic technique did not affect the subsequent need for surgery in this sample.
Subsequent surgical fixation was carried out in 41% of patients who underwent manipulation of Colles' type wrist fractures in this cohort. This merits further research and represents a potential target to rationalise repeat procedures.
桡骨远端 Colles 骨折是急诊科最常处理的骨折之一。当地的审核数据表明，这些损伤中有很大一部分需要进行后续的手术固定。如果这种情况普遍存在，可能会给患者和 NHS 带来潜在的负担，值得进一步研究。本研究的目的是评估急诊科处理桡骨远端 Colles 型骨折后行手术固定的比例，并探讨英国急诊科对这些骨折的处理方式存在的差异。
我们在英国的 16 家急诊科进行了一项多中心观察性研究，时间为 2019 年 2 月 4 日至 3 月 31 日。所有在急诊科接受骨折手法复位的成年 Colles 骨折患者均纳入研究。排除无法随访和存在掌侧移位骨折的患者。我们测量了 6 周时腕部骨折手术的比例、患者的人口统计学特征以及使用的麻醉技术的差异。
在研究期间，共有 328 名成年患者因桡骨远端骨折到参与研究的急诊科就诊。其中 83 名患者在急诊科接受了骨折手法复位，符合研究条件。他们的平均年龄（标准差）为 65.3（17.0）岁，84.3%为女性，最常用的麻醉方法是血肿阻滞（38.6%）。34 名（41.0%，95%CI 30.3 至 52.3）患者的骨折随后接受了手术固定。年龄较小与更高的手术固定率相关，但在本样本中，急诊科的麻醉技术并不影响随后手术的需求。
在接受 Colles 型腕部骨折手法复位的患者中，有 41%的患者随后接受了手术固定。这值得进一步研究，并代表了一个潜在的目标，可以使重复手术更加合理化。
