Outcome of functional treatment with a Lucerne Cast in patients with hand fractures: a retrospective case series.

PURPOSE: The purpose of this study was to determine the clinical outcome of patients treated with a functional Lucerne Cast (LuCa) for different types of hand fractures. Static casting has traditionally been the preferred treatment for hand fractures. However, functional casting may lead to good functional outcomes, less stiffness, and earlier return to work. METHODS: A retrospective case series of all consecutive patients with a metacarpal or proximal phalangeal fracture treated with a LuCa between 2018 and 2019 was conducted. A total of 90 patients were included. Clinical data were collected directly from the patient's medical records. Functional outcome was assessed with the Michigan Hand Outcomes Questionnaire (MHQ). RESULTS: The median MHQ score was 95 (IQR 83-100) with a median follow-up of 23 months. Complications occurred in 7 of 90 patients (8%). Functional impairment occurred in two (2%) patients. Functional impairment was defined as stiffness, persisting rotational deformity, a boutonnière or swanneck deformity. Persisting pain or CRPS occurred in six (7%) patients. CONCLUSION: The LuCa shows to be effective in the functional treatment of both metacarpal and proximal phalangeal fractures with excellent patient-reported outcomes but at a relatively high rate of persisting pain.

Optimizing orthopedic trauma care delivery during the COVID-19 pandemic. A closed-loop audit of implementing a virtual fracture clinic and fast-track pathway in a Dutch level 2 trauma center.

BACKGROUND: Guidelines concerning outpatient management of patients during the coronavirus pandemic required minimized face-to-face follow-up and increased remote care. In response, we established a virtual fracture clinic (VFC) review for emergency department (ED) patients with musculoskeletal injuries, meaning patients are reviewed 'virtually' the next workday by a multidisciplinary team, instead of routine referral for face-to-face fracture clinic review. Patients wait at home and are contacted afterwards to discuss treatment. Based on VFC review, patients with minor injuries are discharged, while for other patients an extensive treatment plan is documented using injury-specific care pathways. Additionally, we established an ED orthopedic trauma fast-track to reduce waiting time. This study aimed to evaluate the extent to which our workflow supported adherence to national coronavirus-related guidelines and effects on ED waiting time. METHODS: A closed-loop audit was performed during two 4-week periods using predefined standards: (1) all eligible ED orthopedic trauma patients are referred for VFC review; (2) reached afterwards; and follow-up is (3) patient initiated, or (4) performed remotely, whenever possible. Total ED waiting time, time to review, time for review, and time after review were assessed during both audit periods and compared with previous measurements. RESULTS: During both audits, the majority of eligible ED patients were referred for VFC review (1st: n=162 (88.0%); 2nd: n=302 (98.4%)), and reached afterwards (1st: 98.1%; 2nd: 99.0%). Of all referred patients, 17.9% and 13.6% were discharged 'virtually' during first and second audits, respectively, while 45.0% and 41.1% of scheduled follow-up appointments were remote. Median total ED waiting time was reduced (1st: -36 minutes (p<0.001); 2nd: -33 minutes (p<0.001)). During the second audit, median ED time to review was reduced by -13 minutes (p<0.001), as well as time for review: -10 minutes (p=0.019). DISCUSSION: In line with national guidelines, our VFC review allowed time-effective review and triage of the majority of ED orthopedic trauma patients, supporting patient-initiated and remote follow-up, whenever possible. ED waiting time was reduced after implementing the VFC review and orthopedic trauma fast-track. LEVEL OF EVIDENCE: IV.

[The Amsterdam Wrist Rules app: An aid for the triage of patients with wrist trauma]. / De 'Amsterdam wrist rules'-app.

OBJECTIVE: To evaluate the safety of implementing the Amsterdam Wrist Rules (AWR) during Emergency Department (ED) nurse triage, and to assess the potential reduction of radiographic images. DESIGN: Prospective cohort study METHODS: Based on patient characteristics and clinical variables the AWR-application advised triage nurses if radiographic imaging was necessary of patients (>3 years) presenting with trauma of the wrist. The triage nurse was allowed to perform radiographic imaging if the advice was negative. Safety was assessed by the number of missed clinically relevant distal radius fractures (DRFs) when the AWR advised not to perform imaging. The potential reduction of radiographic images was assessed by the proportion of patients in whom the AWR-application advised not to perform imaging. Compliance was defined as following this advice. Patient satisfaction was assessed if no radiographic imaging was performed. RESULTS: The AWR-application advised not to perform imaging in 18% of children (n=153) and in 9% of adults (n=204). In children, one clinically relevant DRF was missed (sensitivity 99%, specificity 33%) and none in adults (sensitivity 100%, specificity 19%). The compliance was 22% in children and 32% in adults. If no radiographic imaging was performed, 100% of children and 75% of adults were satisfied. CONCLUSION: Implementation of the AWR during ED nurse triage of patients presenting with wrist trauma can safely contribute to reducing unnecessary radiographic imaging. If other injuries than a clinically relevant DRF are suspected based on triage, an ED physician should decide if imaging is necessary.