Fracture clinics are often characterised by the referral of large
numbers of unselected patients with minor injuries not requiring
investigation or intervention, long waiting times and recurrent
unnecessary reviews. Our experience had been of an unsustainable
system and we implemented a ‘Trauma Triage Clinic’ (TTC) in order
to rationalise and regulate access to our fracture service. The
British Orthopaedic Association’s guidelines have required a prospective evaluation
of this change of practice, and we report our experience and results. We review the management of all 12 069 patients referred to our
service in the calendar year 2014, with a minimum of one year follow-up
during the calendar year 2015. Aims
Patients and Methods
Both conservative and operative forms of treatment
have been recommended for patients with a ‘floating shoulder’. We
compared the results of conservative and operative treatment in
25 patients with this injury and investigated the use of the glenopolar
angle (GPA) as an indicator of the functional outcome. A total of
13 patients (ten male and three female; mean age 32.5 years (24.7
to 40.4)) were treated conservatively and 12 patients (ten male
and two female; mean age 33.67 years (24.6 to 42.7)) were treated
operatively by fixation of the clavicular fracture alone. Outcome
was assessed using the Herscovici score, which was also related
to changes in the GPA at one year post-operatively. The mean Herscovici score was significantly better three months
and two years after the injury in the operative group (p <
0.001
and p = 0.003, respectively). There was a negative correlation between
the change in GPA and the Herscovici score at two years follow-up
in both the conservative and operative groups, but neither were
statistically significant
(r = -0.295 and r = -0.19, respectively). There was a significant
difference between the pre- and post-operative GPA in the operative
group (p = 0.017). When compared with conservative treatment, fixation of the clavicle
alone gives better results in the treatment of patients with a floating
shoulder. The GPA changes significantly with fixation of clavicle
alone but there is no significant correlation between the pre-injury
GPA and the final clinical outcome in these patients. Cite this article:
