Virtual fracture clinic management of fifth metatarsal, including Jones’, fractures is safe and cost-effective

Abstract Introduction Virtual Fracture clinics (VFCs) are an alternative to the traditional fracture clinic. Recent evidence reports them to be safe, cost-effective, and efficient model without significant compromise to patient care. Aim This audit aims to assess VFC referrals from the paediatric emergency department (ED) and ensure the appropriateness of these referrals. Method This was a retrospective audit done at a large district general hospital in the United Kingdom (UK). We included patients under 18 years old presented to the emergency department with suspected or confirmed fractures and referred to virtual fracture clinics within a period of one month. The performance was measured against both local and national guidance (NICE & BOAST 7). Results Thirty patients were eligible. Thirty-three per cent of patients were appropriately referred to the VFC and ’seen’ within 72 hours. Comparing those referred 63.3% were appropriate, with inappropriate referrals mainly due to false-positive fracture diagnosis or fractures safe to be discharged home. Only 67.8% per cent of patients were managed correctly as per suspected or confirmed diagnosis with regards to fixation (i.e., splint). Conclusions The target of 100% compliance has failed. Fractures deemed safe to be discharged home from the ED are being repeated referred, radiographic interpretations often over-diagnose, and management within the department in sub-optimal. Recommendations include improving junior radiographic interpretation skills and awareness of the local and national guidelines, with another audit cycle to assess for improvement.

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1254 Virtual Fracture Clinic Management of Little (5th) Metacarpal Neck Fractures; a Safe and Feasible Option?

British Journal of Surgery ◽

10.1093/bjs/znab259.1036 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

O Townley ◽

M Flatman ◽

A Hoyle ◽

G Eastwood

Keyword(s):

Fracture Pattern ◽

Patient Contact ◽

Electronic Patient Records ◽

Clinic Attendance ◽

Fracture Clinic ◽

Face To Face ◽

Clinic Management ◽

Patient Demographics ◽

Feasible Option ◽

Virtual Fracture Clinic

Abstract Aim To determine the safety and efficacy of a Virtual Fracture Clinic (VFC) in managing little metacarpal neck fractures. Method Retrospective review of consecutive little MC neck fractures presenting to the ED June-December 2020 and subsequently referred on to VFC. Patient demographics and clinic outcomes were reviewed using electronic patient records and radiographs. Results Fifty patients were identified (Male:Female 37:13; mean age 26 years, range 3-89 years). Of these, 41/50 were discharged directly following VFC advice, with no adverse event. The remaining 9/50 had a face-to-face Fracture Clinic review due to safeguarding concerns (2), concurrent neck of fourth MC fracture (2), concerns regarding fracture pattern (4), and an unclear indication (1). These 9/50 were discharged after single review, with no adverse events to date. Conclusions Our data suggest that VFC review of patients with little MC neck fractures is a safe and feasible means of patient care which has the potential to reduce the requirement of face-to-face patient contact during the Covid-19 pandemic and reduce fracture clinic attendance. We suggest the routine incorporation of a Virtual Fracture Clinic for these hand injuries. Further work is needed to formally investigate associated patient satisfaction and the application of this approach to other trauma presentations.

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Standardised virtual fracture clinic management of Achilles tendon ruptures is safe and reproducible

Foot and Ankle Surgery ◽

10.1016/j.fas.2018.10.010 ◽

2019 ◽

Vol 25 (6) ◽

pp. 782-784 ◽

Cited By ~ 3

Author(s):

Alastair Robertson ◽

Charles Godavitarne ◽

Simon Bellringer ◽

Enis Guryel ◽

Felicity Auld ◽

...

Keyword(s):

Achilles Tendon ◽

Fracture Clinic ◽

Clinic Management ◽

Tendon Ruptures ◽

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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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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Paediatric orthopaedics in lockdown

Bone & Joint Open ◽

10.1302/2633-1462.17.bjo-2020-0086.r1 ◽

2020 ◽

Vol 1 (7) ◽

pp. 424-430

Author(s):

Ian Baxter ◽

Graeme Hancock ◽

Matthew Clark ◽

Matthew Hampton ◽

Adelle Fishlock ◽

...

Keyword(s):

Trauma Centre ◽

Supracondylar Fractures ◽

Cast Immobilization ◽

Fracture Clinic ◽

Clinic Management ◽

Orthopaedic Patients ◽

Major Trauma Centre ◽

Limb Injuries ◽

Proportional Increase ◽

The Impact

Aims To determine the impact of COVID-19 on orthopaediatric admissions and fracture clinics within a regional integrated care system (ICS). Methods A retrospective review was performed for all paediatric orthopaedic patients admitted across the region during the recent lockdown period (24 March 2020 to 10 May 2020) and the same period in 2019. Age, sex, mechanism, anatomical region, and treatment modality were compared, as were fracture clinic attendances within the receiving regional major trauma centre (MTC) between the two periods. Results Paediatric trauma admissions across the region fell by 33% (197 vs 132) with a proportional increase to 59% (n = 78) of admissions to the MTC during lockdown compared with 28.4% in 2019 (N = 56). There was a reduction in manipulation under anaesthetic (p = 0.015) and the use of Kirschner wires (K-wires) (p = 0.040) between the two time periods. The median time to surgery remained one day in both (2019 IQR 0 to 2; 2020 IQR 1 to 1). Supracondylar fractures were the most common reason for fracture clinic attendance (17.3%, n = 19) with a proportional increase of 108.4% vs 2019 (2019 n = 20; 2020 n = 19) (p = 0.007). While upper limb injuries and falls from play apparatus, equipment, or height remained the most common indications for admission, there was a reduction in sports injuries (p < 0.001) but an increase in lacerations (p = 0.031). Fracture clinic management changed with 67% (n = 40) of follow-up appointments via telephone and 69% (n = 65) of patients requiring cast immobilization treated with a 3M Soft Cast, enabling self-removal. The safeguarding team saw a 22% reduction in referrals (2019: n = 41, 2020: n = 32). Conclusion During this viral pandemic, the number of trauma cases decreased with a change in the mechanism of injury, median age of presentation, and an increase in referrals to the regional MTC. Adaptions in standard practice led to fewer MUA, and K-wire procedures being performed, more supracondylar fractures managed through clinic and an increase in the use of removable cast. Cite this article: Bone Joint Open 2020;1-7:424–430.

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