gms | German Medical Science

Objectives: To investigate the usefulness of the routinely planned six week outpatient visit and X-ray in patients treated surgically for the most common upper extremity fractures including clavicula, proximal hu-merus, humerus shaft, olecranon, radial shaft and distal radius.

Methods: This was a retrospective snapshot 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 X-ray made at the 6-weeks outpatient visit. Ab-normalities were defined as all differences between the intra-operative (or direct postoperative) and 6-weeks X-ray. In case an abnormality was detected, the hospital records were screened to deter-mine its clinical consequence. The clinical consequences were categorized into requiring either addi-tional diagnostics, additional interventions, change of standard postoperative immobilization, weightbearing or allowed range of motion (ROM).The second outcome of interest was the inci-dence of deviations from the local standard post operative treatment and follow-up protocol based on the 6-weeks outpatient visit as a whole. Deviations were also categorized into either requiring additional diagnostics, additional interventions, change of standard postoperative immobilization, weightbearing or allowed range of motion.

Results and conclusion: A total of 267 patients were included. Abnormalities on X-ray at 6-weeks were found in only 10 (3.7%) patients of which only 4 (1.5%) had clinical implications (in three patients extra imaging was required and in one patient it was necessary to deviate from standard weightbearing/ROM limita-tion regime). The clinical/radiological findings during the 6-weeks outpatient visit led to a deviation from standard in only 8 (3.0%) patients. Notably, the majority of these patients experienced symp-toms suggestive for complications.

The routine 6-weeks outpatient visit and X-ray, 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.