Routine 6-weeks outpatient visit in patients treated surgically for upper extremity fractures: is it truly necessary?

Background

Due to the increasing burden on the heatlhcare system the usefulness of the routinely planned 6-week outpatient visit and radiograph in patients treated surgically for the most common upper extremity fractures, including clavicle, proximal humerus, humeral shaft, olecranon, radial shaft, and distal radius, should be investigated.

Method

This was a retrospective cohort study of all patients treated surgically for the most common upper extremity fractures between 2019 and 2022 in a level 1 trauma center. The first outcome of interest was the incidence of abnormalities found on the radiograph taken at the 6-week outpatient visit. Abnormalities were defined as all differences between the intraoperative (or direct postoperative) and 6-week radiograph. In case an abnormality was detected, the hospital records were screened to determine its clinical consequence. The clinical consequences were categorized into requiring either additional diagnostics, additional interventions, change of standard postoperative immobilization, weightbearing, or allowed range of motion (ROM). The second outcome of interest was the incidence of deviations from the local standard postoperative treatment and follow-up protocol based on the 6-week outpatient visit as a whole. Deviations were also categorized into either requiring additional diagnostics, additional interventions, change of standard postoperative immobilization, weightbearing, or allowed ROM.

Results

A total of 267 patients were included. Abnormalities on radiograph at 6 weeks postoperatively were found in only 10 (3.7%) patients, of which only 4 (1.5%) had clinical implications (in 3 patients extra imaging was required and in 1 patient it was necessary to deviate from standard weightbearing/ROM limitation regimen). The clinical/radiologic findings during the 6-week outpatient visit led to a deviation from standard in only 8 (3.0%) patients. Notably, the majority of these patients experienced symptoms suggestive of complications.

Conclusion

The routine 6-week outpatient visit and radiograph, after surgery for common upper extremity fractures, rarely has clinical consequences. It should be questioned whether these routine visits are necessary and whether a more selective approach should be considered.