Title : A clinical audit assessing patients presenting with a supracondylar fracture
Abstract:
Introduction: Supracondylar fractures are the most common elbow injuries in children where the common mechanism of injury is fall on outstretched hand with hyperextension of the elbow. Displaced supracondylar fractures can present with a neurovascular deficit and severe injuries can be limb threatening. The management of these injuries can be conservative or surgical, depending on the severity of the injury. British Orthopaedic Association Standards for Trauma and Orthopaedics (BOAST) have provided guidelines for the management of supracondylar fractures where the importance of documentation of the neurovascular status has been highlighted.
Aims: The primary aim of this audit was to assess the adherence to BOAST guidelines with regards to documentation of the neurovascular status locally at the Musgrove Park Hospital.
Methods: The patients were reviewed retrospectively from Mrach 2020-June 2024. As the clerking of the patients is done electronically on EPRO at Musgrove Park Hospital, the clerking notes were
reviewed retrospectively for patients presenting with a supracondylar fracture. The documentation of radial pulse, capillary refill time and the function of anterior interosseous nerve, medial radial and ulna nerves were assessed. The data was recorded in Microsoft Excel on an NHS computer.
Results: Overall, 65 clerking notes were reviewed. The presence of radial pulse was only documented for 23 patients (35.4%), capillary refill time was not documented for 32 notes (49.2%) and median nerve function was not documented for 12 patients (18.5%). The anterior interosseous nerve function was not documented for 18 patients (27.7%). Additionally, ulna and radial nerve function was not documented for 13 patients (20%).
Recommendation and Conclusion: The main limitation of this clinical audit was that this was done retrospectively with a small sample size. Poor documentation of the neurovascular status was observed overall. Out of all the domains assessed, capillary refill time was not documented in most patients. The results of this audit were presented locally at the monthly audit meeting and the possibility of developing a proforma for documentation of the neurovascular status was discussed. A second cycle of this audit is required to ensure that the local practice has been improved.