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


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

In This Article

Pediatric Trauma

A "home management" protocol for stable pediatric fractures, with VFC review of all cases was implemented by Robinson et al.[12] This home management protocol included children over 18 mo of age and excluded open injuries, those with neurovascular compromise, and those that were displaced or potentially unstable. In cases where there was a suspicion of nonaccidental injury, management was according to the local safeguarding policy. The protocol included management of stable metacarpal, phalangeal, metatarsal, lateral malleolar fracture (for children over 5 yr), wrist fractures (nondisplaced or torus), and elbow fractures (for children over 5 yr). The key aspect was that injuries were managed with splints rather than cast immobilization. Metacarpal fractures with no rotational deformity and angulation less than 60 degrees were managed with a Bedford finger splint for 4 wk. Minor phalangeal avulsion fractures were managed in a similar fashion. For nondisplaced wrist fractures (distal radius/ulna), torus fractures, or when no fracture was seen, patients were managed with a wrist splint until pain free. Plastic deformation of up to 20 degrees was also accepted for the home management program.[12]

Children with nondisplaced or unseen metatarsal or lateral malleolar fractures (children 5 yr and over) were managed with a weight-bearing boot until pain free. Six months after the VFC was implemented, 164 patients were reviewed over a 3-month period. Of these patients 47.6% had no definite fracture on initial radiograph. Patients that required a "face-to-face" review in clinic were 6.7% (n=11/164) of the total patients; all were discharged after the clinic appointment, except for one child who continued to have elbow pain and required a cast and a further follow-up appointment. The protocol resulted in a higher proportion of patients who had their care managed by a consultant pediatric specialist, with no serious adverse consequences. It was estimated that three VFC reviews could be performed in the same time as a single face-to-face fracture clinic review. The social, educational, and financial benefits to the child and parent and employer were not evaluated.[12]

Therefore, home-based management with VFC review was found to be effective in the management of the pediatric population with fractures.