Improved Outcome of Fracture Treatment by Early Operative Reduction: Results of a Surgical Audit

Abstract

An audit is a useful means of examining improvements in the art and science of clinical practice. We applied this to surgery to determine improved outcomes of fracture treatment by early operative reduction. This was carried out at the University of Ilorin Teaching Hospital, Ilorin, Nigeria, by comparing two years, 1997 when there was less emphasis and 1998 when there was a greater emphasis on operative reduction of fractures. Hospital records in the orthopaedic wards, operating rooms and the physiotherapy unit of all patients admitted were reviewed retrospectively. Two years, 1997 and 1998 were analysed for age, sex, type of treatment and quality of outcome. A total of 247 admissions into orthopaedic wards were made in 1997 leading to 79 major operations, 20 of which were operative reduction of fractures (25.3 %). In 1998, 239 patients were admitted out of which 174 major operations were performed, 72 of which were operative reductions (41.4 %, P = 0.014). Patients' stay in hospital was shorter in 1998 with 81% of patients staying 3 months and less compared to 40 % in 1997 (P = 0.000). Improved outcome of stiff knee joints from physiotherapy was judged good and excellent in 66.7 % and 20 % in 1998 compared to 28.3 % (P = 0.00005) and 1.9 % (P = 0.003) in 1997, respectively. These results suggest generally improved outcome when fractures are treated by early operative reduction because of shorter hospital stay, early return to work, improved nursing care and joint function.

(Nig J Surg Res 2000; 2:114-122)



KEY WORDS:

Surgical Audit, Operative reduction, Fractures, Outcome