Orthopaedic Consultation Versus No Consultation for Clavicle, Radial Head, and Proximal Humerus Fractures: Association with Post-Imaging Emergency Department Length of Stay

Background/Objectives: To evaluate the association between orthopaedic consultation and Emergency Department (ED) length of stay among patients with clavicle, radial head, and proximal humerus fractures meeting criteria for nonacute management (discharge without orthopaedic consultation). Methods: All adult patients presenting to a single Level 1 trauma centre between 2019 and 2022 with a clavicle, radial head, or proximal humerus fracture that met criteria for nonacute management (discharge without orthopaedic consultation) were identified from an institutional database. Post-imaging ED length of stay, defined as time from radiograph completion to discharge or admission, was compared between patients discharged per protocol without orthopaedic consultation and those discharged after receiving orthopaedic consultation. A mixed-effects linear log regression model with orthopaedic surgery consult, age and sex as fixed effects and year of presentation as a random intercept was used to model the effect of not having an orthopaedic surgery consult on length of stay. A post hoc sensitivity analysis excluding patients who were admitted was performed. Results of the regression model are presented with corresponding 95% confidence intervals. Results: This study included 523 patients (average age 57 years, 58% female) with 115 clavicle, 269 proximal humerus, and 139 radial head fractures. Among patients meeting criteria for nonacute management, those who were discharged per protocol without orthopaedic consultation had a 59%, 56%, and 55% reduction in length of stay for clavicle, radial head, and proximal humerus fractures, respectively (all p < 0.001). Only 3/523 (0.6%) were admitted to orthopaedic surgery. Results were consistent in post hoc sensitivity analysis. Conclusions: Discharge without orthopaedic consultation among patients with clavicle, radial head, or proximal humerus fractures meeting criteria for nonacute management was associated with substantially shorter ED length of stay. Adherence to this protocol may aid in reducing overcrowding in the ED.