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Highlights Virtual clinics improved adherence to the BOAST COVID-19 guidelines. An early consultant opinion reduces face to face clinic appointments, rationing resources, improving efficiency and clinical safety. Virtually assessing the 26 patients who were incorrectly initially seen face-to face would have saved 22 appointments and 13 Xray attendances. Triaging all patients through virtual clinic improved compliance to the BOAST COVID-19 guidelines to 99%.

Purpose The COVID pandemic has decreased orthopaedic fracture operative intervention and follow-up and increased the use of virtual telemedicine clinics. We assessed the implications of this management on future orthopaedic practice. We also surveyed patient satisfaction of our virtual fracture follow-up clinics. Method We prospectively analysed 154 patients during two weeks of 'lockdown' assessing their management. We surveyed 100 virtual fracture clinic follow-up patients for satisfaction, time off work and travel. Results Forty-nine percent of patients had decisions affected by COVID. Twelve percent of patients were discharged at diagnosis having potentially unstable fractures. These were all upper limb fractures which may go onto mal-union. Twenty-nine percent of patients were discharged who would have normally had clinal or radiological follow-up. No patients had any long-term union follow-up. Virtual telemedicine clinics have been incredibly successful. The average satisfaction was 4.8/5. In only 6% of cases, the clinician felt a further face-to-face evaluation was required. Eighty-nine percent of patients would have chosen virtual followup under normal conditions. Conclusion Lessons for the future include potentially large numbers of upper limb mal-unions which may be symptomatic. The non-union rate is likely to be the same, but these patients are unknown due to lack of late imaging. Telemedicine certainly has a role in future orthopaedic management as it is well tolerated and efficient and provides economic and environmental benefits to both clinicians and patients.

Coracoid pain is not a common presenting symptom in the shoulder clinic, however a small minority of patients do present complaining of pain well localised to the coracoid. To aid clinicians we present the findings of a review of the literature on coracoid pain. We divide the causes of pain into soft tissue and bony causes. We review and discuss the literature and present the evidence on diagnostic investigations and treatments.