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The Majority of Patients Prefer Optional Follow-up for Simple Upper Extremity Fractures
David Ring, MD, PhD1; Teun Teunis, MD2; Abigail Finger, BSc2, Michiel Hageman, MD, AMC3; Valentin Neuhaus, MD2
1Dell Medical School, Austin, TX; 2Massachusetts General Hospital, Boston, MA; 3Amsterdam, Netherlands

Many common arm fractures have an excellent prognosis with little more than symptomatic treatment and an additional follow-up visit after diagnosis might not always be necessary. This study tested the primary null hypothesis that there is no difference in disability (Quick DASH) 2 to 6 months after injury between patients with and without an additional follow-up visit. Secondarily we assessed (1) differences in pain, satisfaction and return to work at 2 to 6 months after injury and (2) differences between patients choosing an optional or scheduled follow-up.

We prospectively enrolled 120 patients with well-aligned single metacarpal fractures (n=63), non- or minimally displaced distal radius fractures (n=39) and isolated non- or minimally displaced radial head fractures (n=18). The subjects then chose whether or not to schedule an additional appointment for evaluation of their fracture. At enrollment we recorded patient demographics, depression (Patient Health Questionnaire-2), Pain Self-Efficacy Questionnaire, disability (QuickDASH), a 0-10 ordinal rating of pain intensity, and satisfaction rated on an 11-point ordinal scale. Eighty-two (68%) subjects were available when contacted by phone or email 2-6 months after injury at which time we measured disability, numerical rating scale for pain and satisfaction, and employment. Eleven subjects (17%) of subjects who chose an optional follow-up returned for a follow-up visit. Nine subjects (16%) of subjects who scheduled a follow-up visit did not return. There were no adverse events in either group.

Multivariable analysis accounting for difference in baseline characteristics showed no difference in QuickDASH between 2 and 6 months after fracture between patients with and without an additional visit (optional follow-up: ? -1.5, 95%CI -8.6 to 5.5, SE=3.5, P=0.67). There were no differences in pain, satisfaction, or return to work. On multivariable logistic regression analysis, no variables were independently associated with choosing optional or scheduled follow-up.

In an urban academic hand surgery office, most patients prefer optional follow-up for simple upper extremity fractures with a good prognosis. There were no adverse events and there were equal outcomes and satisfaction among patients that did and did not return. Hand surgeons can safely consider offering patients with low-risk hand fractures an optional instead of a scheduled second visit, avoiding unnecessary waiting, travel, inconvenience, time, tests, and costs.

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