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COMPARISON OF FRACTURE FOLLOW‐UP RATES IN ABORIGINALS VERSUS NON‐ABORIGINALS IN AN AUSTRALIAN PERIPHERAL HOSPITAL – BROKEN BUT DID WE FIX IT?
Author(s) -
Piper B. J.,
Ting D.,
Plaumann L.,
Turner P.
Publication year - 2009
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/j.1445-2197.2009.04929_4.x
Subject(s) - medicine , conservative management , incidence (geometry) , attendance , retrospective cohort study , indigenous , population , conservative treatment , surgery , ecology , physics , environmental health , optics , economics , biology , economic growth
Purpose: To determine the rate of orthopaedic follow‐up of Aboriginal patients and the implications of this on fracture management. Aboriginal patients are at a high risk of complications after fracture given the high incidence of fractures, co‐morbidities and later presentation. There is no information in the literature on follow‐up of Aboriginal patients after fracture. Methodology: Retrospective review of patients presenting to Kalgoorlie Hospital with a fracture over 12 months. Attendance at follow‐up, injury type, treatment type (surgical or non‐surgical), indigenous status, and distance from hospital were recorded. Results: A total of 267 patients were identified over a 12 month period, 20% were Aboriginal. Aboriginal patients were ten‐fold more likely to be lost to follow‐up when compared to non‐Aboriginal patients (40% and 4% respectively). Follow‐up was further reduced in the Aboriginal group treated surgically (45%) and improved in the conservative group (17%). This pattern was reversed for non‐Aboriginal patients where the surgically treated group more likely to present for follow‐up. Conclusion: The follow‐up of Aboriginal patients is very poor. Our study clearly demonstrates that low follow‐up rates are not only related to geographical isolation but the hospital experience itself and mode of management. The failure of Aboriginal patients to present for follow‐up has major implications for the management of fractures in this high risk population. We discuss the implications of more conservative treatment to increase follow‐up and the conflicting evidence to aggressively internally fix fractures in patients with poor compliance and co‐morbidities such as diabetes, common in Aboriginal patients.