Q3.1 When should definitive treatment begin? (Person number: Comments) 2: If treatment is ineffective, delay doesn't matter. Is manipulation the right treatment? What is the outcome of interest? Alignment, function, etc? 4: Within extended working day, immediate referral to orthopaedics for assessment/ treatment. Out of extended working hours, mild to moderate displacement, volar slab, sling, analgesic, review orthopaedics 9 am. Significant displacement, immediate orthopaedic involvement. 5: Day of injury or within 48 hours. Research: Early reduction prevents complications. 7: ASAP to keep in line with physiology of bone healing. 8: ASAP. Research: More high volume RCTs. This is an important element in practice. 9: Most delays in surgery for emergencies result in increased morbidity – e.g. in RSD? 11: This depends on extent of displacement and/or soft tissue injury. Optimally fracture reduction best done within 24 hours. Research: Regardless of whether fracture equally reducible later it is better for patient comfort and economically better to do at time of presentation. 14: Immediate. 17: In practice undertaken ASAP. Don't see any advantage in delaying manipulation. 19: In 24–48 hours, provided no neurovascular damage is present. 23: I believe treatment should be immediate to avoid problems with nerve damage, stiffness etc. Research: Immediate treatment must be proven to be beneficial. 25: At first reasonable opportunity given resource and personnel. 27: Research: previous trial of unknown effectiveness but I'm not sure you would be granted ethics committee approval to conduct similar trial. | ||||||||||||||||||||||||||||
N | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 | 14 | 15 | 16 | 17 | 18 | 19 | 20 | 21 | 22 | 23 | 24 | 25 | 26 | 27 | 28 |
R | Â | 1 | Â | Â | 2 | 0 | 0 | 2 | Â | Â | 1 | Â | Â | 0 | 2 | Â | 0 | Â | 2 | 0 | Â | Â | 2 | Â | 0 | Â | 1 | Â |