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Treating hand fractures

Population-based study of acute health care use in British Columbia

Samuel S. Sheps, MD FRCPC MSc
Professor and researcher in the Department of Health Care and Epidemiology at the University of British Columbia

Correspondence to: Dr L.M. Feehan, Division of Orthopaedic Engineering Research, Department of Orthopaedics, VGH Research Pavilion, 500—828 W 10th Ave, Vancouver, BC V4Z 1L8; telephone 604 875-4111, extension 66294; fax 604 875-4851; e-mailFeehan{at}interchange.ubc.ca

OBJECTIVE To examine trends in use of acute health care services for hand fractures in a large diverse population across a range of medical settings.

DESIGN Retrospective review of data from the British Columbia Linked Health Dataset on patients who had been treated for hand fractures between May 1, 1996, and April 30, 2001.

SETTING British Columbia.

PARTICIPANTS A total of 72 481 British Columbia residents identified from the British Columbia Linked Health Dataset as having received treatment for hand fractures.

MAIN OUTCOME MEASURES Initial treatment for fractures (who had provided treatment and where had the treatment taken place) and hospital use (type of hospital, physician responsible, wait time, length of stay, geographic variation).

RESULTS Almost all patients (97%) with hand fractures received initial treatment as outpatients. Just over half these patients (54%) received initial care in nonhospital settings, and more than two-thirds (70%) received initial care from primary care physicians. By far most patients (90%) were treated conservatively without surgical intervention. The few patients with more complicated hand fractures (10%) were most commonly treated in day surgery settings by specialist surgeons within 2 days of first presentation. Patients in the more rural, isolated, northern region of British Columbia had higher hospital admission rates (relative risk 2.1) for hand fractures than patients in other regions did.

CONCLUSION In contrast to other common fracture injuries that are routinely managed by specialist surgeons, most hand fractures in BC were managed initially as nonemergency medical problems by primary care physicians. Almost all patients were treated conservatively without surgical intervention. The few patients with more complicated hand fractures were referred to and treated quickly by specialist surgeons. Focused training and continuing education opportunities for primary care physicians on new approaches to management of acute hand fractures will ensure that patients with hand fractures in British Columbia and the whole of Canada continue to benefit from appropriate management by primarycare physicians.

This article has been cited by other articles:

				L. M Feehan and S. S Sheps Work-related hand fracture injuries in British Columbia, Canada: a population-based BC-linked health data-set study Hand Ther, March 1, 2009; 14(1): 10 - 21. [Abstract] [Full Text] [PDF]