An evaluation of the conservative management of fractures with plaster in a Maltese primary health centre

Abstract

Introduction: Fracture management still remains a grey area in primary care internationally. In Malta, conservative fracture management operates as the Plaster Slab Service, a service which has never been evaluated. The purpose of this study is to assess this service in Mosta Health Centre (MHC) – the only health centre with a 24/7 X-ray service. The objective is to find common trends and to increase primary care awareness on conservative fracture management. Method: In this cross-sectional study, all patients who had a plaster cast done at MHC between August and December 2017 were included. Retrospective data was collected including demographic data (age, gender, locality), time of application, type of injury and plaster, problems related to the slab and wound healing as well as whether a repeat X-ray was taken. Results: Most plaster casts were required for the younger age group with another peak in the 60s-70s age group. Younger patients showed a significantly increased risk of sustaining a scaphoid or radial fracture. There was a significant link between patients’ locality and time of presentation. Only 44.6% of scaphoid fractures had a repeat X-ray done as follow up. Complications to fracture healing amounted to 1% whilst 5% had problems with the cast. Conclusion: At primary care level, a wide range of fractures can be successfully managed with a very low rate of complications. Possible areas for improvement include guideline adherence in the follow-up of fractures.