Title: Supplementum 269: Abstracts of the 83th annual meeting of swiss orthopaedics
Abstract: ORIF of displaced MSCF is preferred as recent RCTs have shown better healing rates and faster recovery.The influence of patient's demands have not been investigated.We created an evidence-based treatment algorithm (EBTA) for all MSCF including patient's demands and treatment wishes.The aim of this patient-specific stratification was a selection of highly motivated patients in all treatment groups.In January 2021, 5 Swiss centres introduced the EBTA for MSCF and took part in this on-going study.At the time of injury, patients were grouped in high and low-demand and the fractures were classified according to Robinson.All patients with Type A fractures (minimal displacement) and low-demand patients with Type B (displaced) fractures were primarily treated conservatively.High-demand patients with Typ B fractures could choose their treatment after being informed about the actual evidence.Clinical and radiographic follow-up took place at 6 and 12 weeks.Functional outcome, return to work/sport (%), crossovers, complications and revisions within 3 months of were analysed.Within 2 years, 358 patients fulfilled the inclusion criteria.60 patients (17%) were lost to follow-up, leaving 298 patients (80% men) with a mean age of 44yrs.(18-85) for this analysis.Overall, after 3 months: the mean qDASH was 11.7 (0-61), mean SSV 82.1 (15-100), mean elevation was 160° (45-180), VAS pain 0.9 (0-9), back to work/sport 73%/46% (0-100).45 (15%) complications and 21 (7%) unplanned surgeries were recorded.Only 4 (1.3%) patients were classified low-demand.Of the high-demand patients (n = 294), 36 (12%) had a Type A fracture with conservative treatment.Of the 250 patients with Type B fractures, 74 (30%) chose conservative and 176 (70%) ORIF.In these patients, the crossover rate to ORIF was 15% (n = 11) mainly due to pain.ORIF had 19 (11%) complications with 2 (1%) revisions.The complication (p = 0.03) and revision (p <0.01)rate were significantly lower after ORIF.There was no significant difference in the clinical outcome or in return to work/sport between the two groups after 6 and after 12 weeks.Involving the patient into the treatment decision may lead up to 15% of crossovers to ORIF, mainly due to pain within the first weeks.However, with this treatment stratification, there was finally no difference in the early functional outcome and the return to work/sport in patients with displaced MSCFs and the general early outcome was successful.