The Use of Virtual Clinics in the Management of Fractures

A Narrative Review

Benjamin Hickey, BM, MRCS, MSc, FRCS (Tr & Orth), MD; Mithun Nambiar, MBBS, BMedSc; James Randolph Onggo, MBBS (Hons); Mark Whitty, MBBS, FRACS; Harvinder Bedi, MBBS, MPH, FRACS; Raphael Hau, MBBS, FRACS

Disclosures

Curr Orthop Pract. 2020;31(6):582-585. 

In This Article

Abstract and Introduction

Abstract

Virtual fracture clinics (VFC) involve the management and follow-up of appropriate patients through virtual interaction, namely telephone or teleconference consultation and review of imaging. VFCs appear safe for the management of several minor orthopaedic injuries in adults and children. In adults, there is evidence for using a VFC to manage patients with clavicular isolated radial head (Mason 1 and 2), radial neck, and radial styloid fractures, and closed soft-tissue and bony injuries of the hand (excluding carpal and wrist fractures). Stable ankle fractures and fifth metatarsal fractures also can be managed effectively according to VFC protocols. In children, home-based management with VFC review appears effective in management of stable metacarpal, phalangeal, and wrist fractures (undisplaced or torus) and elbow fractures (for children aged over 5 yr). Pediatric metatarsal and lateral malleolar fractures (in patients over 5 yr of age) also can be managed through a VFC.

Introduction

The virtual fracture clinic (VFC), as a component of telemedicine, involves the management and follow-up of patients through virtual interaction, namely phone or teleconference consultation and review of imaging. The process involves the referral of basic orthopaedic injuries to general practitioners for ongoing management. The first and main benefit is to avoid bringing in patients who do not need to be seen in the clinic.[1] Patients with defined minor orthopaedic injuries can be discharged directly from the emergency department (ED) and reviewed in a VFC by orthopaedic staff if necessary. Those who require face-to-face review can be brought to specialist fracture clinics for further management. This collaborative approach between ED staff, orthopaedic staff, general practitioners, and patients can result in more efficient use of resources, which improves performance in the ED by reducing time spent with patients with specified conditions.[2]

The VFC is being increasingly implemented in the United Kingdom, with a study from London, reporting that implementation of VFCs has shown reductions in numbers of face-to-face consultations by over 70% at 6 mo after implementation.[3] Consequently, patients who require face-to-face review are reviewed in clinics sooner. For example, those being seen within 72 hr of initial presentation increased from 5.1% to 46.4% at one health service.[3] The VFC has been introduced in several centers across Australia, and we await studies demonstrating the efficacy of this system in an Australian setting. The aim of this review was to evaluate the current evidence for VFC in the treatment of upper limb, lower limb, and pediatric trauma, and to establish its safety and cost effectiveness. Institutional review board approval was not required for this article.

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