Mohamed Ahmed, Fuad Usman, Shrestha Sagaurav, Elasad Alaa
Trauma and Orthopaedics, Royal Cornwall Hospital, Truro, GBR.
General Practice, Zagazig University, Zagazig, EGY.
Cureus. 2025 Aug 8;17(8):e89644. doi: 10.7759/cureus.89644. eCollection 2025 Aug.
Background and objective Paediatric supracondylar fractures of the humerus are associated with significant neurovascular complications that can result in devastating long-term consequences if not properly assessed and documented. The British Orthopaedic Association Standards for Trauma and Orthopaedics (BOASts) guidelines emphasise the critical importance of comprehensive neurovascular assessment in these patients. This closed-loop audit aimed to evaluate and improve compliance with BOASts guidelines for preoperative neurovascular documentation in paediatric supracondylar fractures at a District General Hospital in the United Kingdom. Methods A retrospective closed-loop audit was conducted over two cycles. The first cycle (January-September 2022) included 24 patients under 15 years with supracondylar fractures. Following implementation of targeted interventions, including staff education and introduction of standardised neurovascular assessment proformas, a second cycle (October 2022-June 2023) was conducted with 34 patients. Data were collected from electronic databases and analysed using Microsoft Excel (Microsoft Corporation, Redmond, Washington, United States). Results Compliance with the BOASts guidelines improved significantly from 45.8% (11/24 patients) in the first cycle to 76.5% (26/34 patients) in the second cycle (p = 0.017). Preoperative neurovascular compromise was identified in 12.5% (3/24) of patients in cycle one and 14.7% (5/34) in cycle two, with all cases resolving postoperatively. One patient in each cycle experienced postoperative neurovascular complications, both of which were successfully managed. Conclusion Implementation of targeted educational interventions and standardised documentation tools significantly improved compliance with the BOASts guidelines for neurovascular assessment in paediatric supracondylar fractures. This audit demonstrates the effectiveness of systematic quality improvement initiatives in enhancing patient safety and clinical documentation standards.
背景与目的 小儿肱骨髁上骨折常伴有严重的神经血管并发症，若评估和记录不当，可能导致严重的长期后果。英国骨科协会创伤与骨科标准（BOASts）指南强调了对这些患者进行全面神经血管评估的至关重要性。这项闭环审核旨在评估并提高英国一家区综合医院对小儿肱骨髁上骨折术前神经血管记录的BOASts指南的依从性。方法 进行了两个周期的回顾性闭环审核。第一个周期（2022年1月至9月）纳入了24例15岁以下的髁上骨折患者。在实施包括员工教育和引入标准化神经血管评估表格等针对性干预措施后，进行了第二个周期（2022年10月至2023年6月），纳入了34例患者。数据从电子数据库收集，并使用Microsoft Excel（美国华盛顿州雷德蒙德市微软公司）进行分析。结果 对BOASts指南的依从性从第一个周期的45.8%（11/24例患者）显著提高到第二个周期的76.5%（26/34例患者）（p = 0.017）。在第一个周期中，12.5%（3/24）的患者术前存在神经血管受损情况，第二个周期中为14.7%（5/34），所有病例术后均得到解决。每个周期各有1例患者发生术后神经血管并发症，均成功处理。结论 实施针对性教育干预措施和标准化记录工具显著提高了对小儿肱骨髁上骨折神经血管评估的BOASts指南的依从性。这项审核证明了系统性质量改进举措在提高患者安全性和临床记录标准方面的有效性。
