Emergency Department management of XXXX : a prospective cohort study.

@entity1 @entity2613 @entity174 @entity7719
OBJECTIVE: To assess radiographic outcomes from @entity7719 . DESIGN: Prospective cohort. SETTING: One tertiary hospital in Western Australia. @entity1 : All @entity1 (184) between ages 21-85 years, presenting to @entity2613 with @entity7719 between 1 April 2006 to 31 July 2008. @entity174 were divided into two groups. Those with <or=15 degrees dorsal angulation were classified as 'minimally displaced' and those with >15 degrees dorsal angulation were classified as 'displaced'. MAIN OUTCOME MEASURES: Radiographic analysis of the dorsal angle on post-reduction and 6 week post- @entity174 X-rays. A combined end-point of poor outcome, as defined by either poor radiological result and/or progression to surgery. RESULTS: In the group of @entity1 with displaced @entity174 , 69 of 114 (61%) went on to have an operation or a poor radiographic outcome versus 8 of 48 (17%) in the group with minimally displaced @entity174 , an absolute difference of 44% (95% CI 30-57%). @entity1 who had a minimally displaced @entity174 with an adequate reduction went on to have a satisfactory 6 week X-ray in 37 of 43 cases (86%; 95% CI 75-96%). @entity1 who had a displaced @entity174 and an adequate reduction had a satisfactory 6 week X-ray in 42 of 86 cases (49%; 95% CI 38-59%). @entity1 who had a displaced @entity174 and an inadequate reduction had a satisfactory 6 week X-ray in only 3 of 22 cases (14%; 95% CI 0-28%). CONCLUSION: The study highlights the importance of the initial 'on arrival' and 'post-reduction' X-rays in the @entity2613 . @entity174 are more likely to go onto poor outcome, as are inadequately reduced @entity174 . Medical officers working in @entity2613 should be aware of the importance of measuring the dorsal angle. They should be referring @entity1 with >15 degrees dorsal angulation to orthopaedics early. Reduction should not be accepted until the dorsal angle has been adequately corrected.
