ABSTRACT
Introduction Supracondylar fractures are the most common elbow fractures in children. Their documentation and management must be done fully and correctly. This Quality Improvement Project (QIP) assessed the quality of documentation for paediatric supracondylar fractures admitted, in accordance with the British Orthopaedic Association Standards for Trauma (BOAST). Methods We present a case series of supracondylar fractures presenting to a single UK-based district general hospital from January 2018 - October 2021. We performed a quality improvement intervention starting in November 2020. The retrospective data prior to intervention (January 2018-November 2020) were deemed "pre-intervention". Prospective "post-intervention" data were collected from April to October 2021. After "pre-intervention" data analysis, an intervention in the form of a documentation proforma was developed and multidisciplinary teaching sessions were delivered. Post-intervention prospective data collection followed from April - October 2021. Results There were 48 and 26 patients in cycles one and two, respectively. The mean age was 6.4 (SD 3.5) and 6.5 (SD 2.7) years, respectively; 42/48 in cycle one and all 26/26 in cycle two required operative management. The mean time to surgery was 1.3 and 0.96 days, respectively. Post-intervention, cycle two showed a reduction in patients with "no neurovascular documentation" pre-reduction (17% vs 12%) and an increase in patients documented as having "neurovascular status intact" (NVI) (44% vs 69%). In post-operative documentation, there was an improvement in documentation with 73% of patients having a post-operative neurovascular assessment documented, versus 50% in the pre-intervention cohort. Conclusion This QIP provided some early improvement in the documentation but with room for future progress as the project continues. It showed proformas can be an effective tool in implementing positive change. It also highlights the need for continuous clinical education across the multidisciplinary teams managing trauma.
ABSTRACT
Tibial plafond fractures (TPFs) are uncommon but potentially devastating injuries to the ankle. Operative treatments include internal and external fixation modalities. This article provides a systematic review of the clinical and functional outcomes of TPFs treated specifically with circular external fixation (CEF). A literature search of medical databases from inception to 13th November 2020 was performed. Original studies written in the English language reporting clinical, radiological, and functional outcome data of TPF treated with CEF were included. Patient demographics, fracture classification, open fractures, post-operative complications, clinical outcomes, radiological outcomes, and functional outcomes were collected. Quality and risk of bias were assessed using standardised scoring tools.In total, 16 studies were included. One prospective randomised study was identified. Collated data of 303 patients were analysed. The mean time to union was 21 weeks. Malunion occurred in 12.4%. The rate of deep infection was 4.8%, but no amputations were recorded. The risk of minor soft tissue infection (including pin-site infections) was 54%. Almost two-thirds achieved good-to-anatomic reduction radiologically. Approximately one-third reported excellent functional outcome scores. The quality of the studies was deemed satisfactory. A moderate risk of bias was acknowledged. This systemic review provides a summary of outcome data regarding CEF as a treatment for TPF. It highlights CEF as an acceptable treatment option with comparable results to that of internal fixation. Further higher-quality evidence is advised.
