Correction to: Virtual fracture clinic reduces patient X‑ray volume for common wrist and ankle fractures

Abstract Background Virtual fracture clinics (VFC) have been widely adopted worldwide as part of the changes in healthcare delivery during the COVID-19 pandemic. They have been shown to be a safe and effective method of delivering trauma care for injuries which do not require immediate intervention or specialist management, whilst maintaining high levels of patient satisfaction. Aims Our aim was to evaluate whether VFCs reduce the volume of X-rays performed for common fractures of the wrist and ankle. Methods A retrospective cohort review was performed. The pre-VFC group consisted of 168 wrist and 108 ankle referrals from March to September 2019. The VFC group included 75 wrist and 68 ankle referrals, during the period March to September 2020. The total number of X-ray images, carried out within a 3-month period for each fracture was summated, with statistical analysis performed following fracture pattern classification. Findings A statistically significant decrease in mean X-rays was observed for isolated stable fracture patterns, such as non-displaced distal radius, − 0.976 (p = 0.00025), and Weber A ankle fractures, − 0.907 (p = 0.000013). A reduction was also observed for more complex fracture patterns such as dorsally displaced distal radius, − 0.701 (p = 0.129) and Weber B ankle fractures, − 0.786 (p = 0.235), though not achieving statistical significance. Conclusions Virtual fracture clinics can reduce X-ray frequency for common stable wrist and ankle fractures, with resultant benefits for both patients and healthcare systems. These benefits may be sustained in patient care beyond the current COVID-19 pandemic.

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Standardised virtual fracture clinic management of radiographically stable Weber B ankle fractures is safe, cost effective and reproducible

Injury ◽

10.1016/j.injury.2017.04.053 ◽

2017 ◽

Vol 48 (7) ◽

pp. 1670-1673 ◽

Cited By ~ 15

Author(s):

S.F. Bellringer ◽

K. Brogan ◽

L. Cassidy ◽

J. Gibbs

Keyword(s):

Cost Effective ◽

Ankle Fractures ◽

Fracture Clinic ◽

Clinic Management ◽

Virtual Fracture Clinic

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688 Rapid Implementation of Virtual Fracture Clinic During COVID 19 Reduces Both Face-To-Face Appointments and Facilitates Rapid Feedback and Education to Be Delivered to The Emergency Department

British Journal of Surgery ◽

10.1093/bjs/znab135.027 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

T Havenhand ◽

L Hoggett ◽

A Bhutta

Keyword(s):

Emergency Department ◽

Patient Flow ◽

Prospective Data ◽

Fracture Clinic ◽

Face To Face ◽

Return Rates ◽

Acute Hospitals ◽

Virtual Fracture Clinic ◽

Improve Patient

Abstract Introduction COVID-19 has dictated a shift towards virtual clinics. Pennine Acute Hospitals NHS Trust serves over a million patients with a significant number of face-to-face fracture clinics. Introduction of a Virtual Fracture Clinic (VFC) reduces hospital return rates and improves patient experience. The referral data can be used to give immediate monthly feedback to the referring department to further improving patient flow. Method Prospective data was collected for all referrals to VFC during March 2020. Data included referral diagnosis, actual diagnosis, referrers grade, and final outcome. Results 630 referrals were made to VFC. 347 (55%) of those referrals were directly discharged without the need for physical consultation. Of these 114 (32%) were injuries which can be discharged by the Emergency Department with an advice leaflet using existing pathways. Of the remaining discharges 102 (29%) were query fractures or sprains; and 135 (39%) were minor fractures; which needed only advice via a letter and no face to face follow up. Conclusions Implementation of VFC leads to a decrease in physical appointments by 55% saving 347 face to face appointments. The new system has also facilitated effective audit of referrals in order to further improve patient flow from the Emergency Department via feedback mechanisms and education.

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Ankle Fracture Classification: A Comparison of Reliability of Three X-ray Views Versus Two

Foot & Ankle International ◽

10.1177/107110079801900809 ◽

1998 ◽

Vol 19 (8) ◽

pp. 555-562 ◽

Cited By ~ 26

Author(s):

Michael E. Brage ◽

Matthew Rockett ◽

Robert Vraney ◽

Robert Anderson ◽

Alicia Toledano

Keyword(s):

Ankle Fracture ◽

Ankle Injury ◽

Ankle Fractures ◽

Kappa Statistics ◽

Fracture Classification ◽

X Ray ◽

Good Accord ◽

Interexaminer Reliability ◽

Intraexaminer Reliability ◽

Good Agreement

Our hypothesis was that malleolar ankle fractures could be classified with two radiographic views as reliably as with three views. Four different observers independently evaluated 99 sets of ankle radiographs. The examiners classified the ankle fractures by using both the Lauge-Hansen and Danis-Weber systems. The interobserver and intraobserver variations were analyzed by kappa statistics. With regard to intraexaminer reliability, the examiners demonstrated excellent accord in classifying the fractures in the Danis-Weber system with either three views or two views. The kappa values were comparable. In the Lauge-Hansen system, three examiners demonstrated excellent accord and one examiner demonstrated good accord in classifying the fractures. Similar kappa values were generated when examiners classified fractures with either three views or two views. With regard to interexaminer reliability, good to excellent accord was demonstrated overall among the four examiners when they used the Danis-Weber system with either three views or two views. The examiners were in good agreement when they used the Lauge-Hansen system. Similar kappa values were generated whether the examiners used three views or two views. Three radiographic views are usually ordered for evaluation of an acute ankle injury. Previous studies have shown that only two views are needed for diagnosis of a malleolar ankle fracture. This study demonstrates that malleolar ankle fractures can be classified with two views, lateral or mortise, with a reliability as good as that achieved with three views. The best agreement is achieved with lateral and mortise views.

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AB066. SOH21AS168. Remote delivery of the satellite virtual fracture clinic—a pilot report of the first 500 cases

Mesentery and Peritoneum ◽

10.21037/map-21-ab066 ◽

2021 ◽

Vol 5 ◽

pp. AB066-AB066

Author(s):

Andrew Jerome Hughes ◽

Darren Patrick Moloney ◽

Caroline Fraser ◽

Joan Dembo ◽

Andrew Hughes ◽

...

Keyword(s):

Fracture Clinic ◽

Virtual Fracture Clinic

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341 Alder Hey Experience of Paediatric Virtual Fracture Clinic During The COVID-19 Pandemic

British Journal of Surgery ◽

10.1093/bjs/znab259.983 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

L Stead ◽

M Ashraf ◽

S Gandham ◽

M Khattak ◽

C Talbot

Keyword(s):

Patient Contact ◽

Fracture Clinic ◽

Social Challenges ◽

Face To Face ◽

Elbow Injuries ◽

Rapid Transition ◽

Clavicle Fractures ◽

Alder Hey ◽

Virtual Fracture Clinic

Abstract Introduction The SARS-CoV2/COVID-19 pandemic represented an unprecedented emergency prompting a drive to minimise non-essential patient contact and the need for a virtual fracture clinic (VFC); an uncommon practice in paediatric units. Management of paediatric fractures requires a greater degree of vigilance to safeguard children. The current climate has created social challenges that theoretically increase the risk of harm and exploitation to children. This study investigates VFC in the management of paediatric fractures to determine the efficiency of such a process and the risk of safeguarding. Method A protocol was devised in affiliation with BSCOS for the immediate management and streamlining of paediatric fractures into VFC. We retrospectively audited 235 VFC consults over a 1-month period. Patient sex was roughly evenly distributed, and age ranged from 9 months to 16 years (mean 8.4 years). Results 42% of patients were recalled for a face-to-face (F2F) review (26% expedited), primarily for clinical assessment, plaster complaints and imaging requirements. 33% were discharged and 15% continued follow-up in VFC. All clavicle fractures were discharged. Forearm, hand, foot and elbow injuries were more likely to be discharged. Lower leg, upper arm and knee presentations more frequently required a F2F review. 2.3% of cases required safeguarding reviews. Conclusions Given the rapid transition to VFC without the use of triage we have determined a number of non-complex fractures safely managed and discharged via VFC. The low percentage of recall due to safeguarding concern highlights this may not be a barrier to the continuation of virtual care outside of the context of a pandemic.

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