A late night call: the patient and the problem

Orthopaedic on-calls are traditionally busy during summer. It was quite late, or rather, early in the morning that I eventually retired to bed. As soon as I managed to go to sleep the mobile went off. “Mr. Hossain”—it was the switchboard on the line—“the SHO [senior house officer] would like a word with you”.

The night on-call SHO had limited previous orthopaedic experience. He had a patient: a 45-year-old male, road traffic accident (RTA) with an isolated sternal fracture. The patient was well and had no other injuries. He had refused analgesia and was keen to be allowed to go home. However, the SHO was worried that he might have sustained occult cardiac injuries. At his previous practice, these patients were investigated and admitted overnight for cardiac monitoring. He was not happy to discharge the patient. What should he do? I had not followed recent literature on this topic. Advising the SHO to admit the patient anyway, I resolved to undertake a comprehensive literature search to investigate and summarise what evidence was available.

Searching for the evidence

I wished to investigate if there was any difference in such outcomes as cardiac complications, morbidity, and death in patients with isolated sternal fracture between hospital admission and immediate discharge. I searched Medline (OVID interface) using this strategy: “P” (patients with isolated …