Virtual Fracture Clinics in Orthopaedic Surgery - A Systematic Review of Current Evidence

Davey, Martin S.; Coveney, Eamonn I; Rowan, Fiachra; Cassidy, J. Tristan; Cleary, May

doi:10.1016/j.injury.2020.11.001

Cited by 26 publications

(34 citation statements)

References 32 publications

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“…This will allow physicians to spend more time on patients with more complex injuries, teaching, training, or improving standards of care. Frequently, studies, including several systematic reviews performed recently [32][33][34], report on the effects of the VFC model as a whole. This model includes both DD of simple stable musculoskeletal injuries, as well as a daily VFC review, consequently including more complex injuries that require follow-up (Fig.…”

Section: Summary Of Evidencementioning

confidence: 99%

Direct discharge of patients with simple stable musculoskeletal injuries as an alternative to routine follow-up: a systematic review of the current literature

Geerdink

Verbist

Dongen

et al. 2021

Eur J Trauma Emerg Surg

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Purpose There is growing evidence that patients with certain simple stable musculoskeletal injuries can be discharged directly from the Emergency Department (ED), without compromising patient outcome and experience. This study aims to review the literature on the effects of direct discharge (DD) of simple stable musculoskeletal injuries, regarding healthcare utilization, costs, patient outcome and experience. Methods A systematic review was performed in Medline, Embase, CINAHL, Cochrane Library and Web of Science using PRISMA guidelines. Comparative and non-comparative studies on DD of simple stable musculoskeletal injuries from the ED in an adult/paediatric/mixed population were included if reporting ≥ 1 of: (1) logistic outcomes: DD rate (proportion of patients discharged directly); number of follow-up appointments; DD return rate; (2) costs; (3) patient outcomes/experiences: functional outcome; treatment satisfaction; adverse outcomes; other. Results Twenty-six studies were included (92% conducted in the UK). Seven studies (27%) assessed functional outcome, nine (35%) treatment satisfaction, and ten (38%) adverse outcomes. A large proportion of studies defined DD eligibility criteria as injuries being minor/simple/stable, without further detail. ED DD rate was 26.7–59.5%. Mean number of follow-up appointments was 1.00–2.08 pre-DD, vs. 0.00–0.33 post-DD. Return rate was 0.0–19.4%. Costs per patient were reduced by €69–€210 (ranging from − 38.0 to − 96.6%) post-DD. Functional outcome and treatment satisfaction levels were ‘equal’ or ‘better’ (comparative studies), and ‘high’ (non-comparative studies), post-DD. Adverse outcomes were low and comparable. Conclusions This systematic review supports the idea that DD of simple stable musculoskeletal injuries from the ED provides an opportunity to reduce healthcare utilization and costs without compromising patient outcomes/experiences. To improve comparability and facilitate implementation/external validation of DD, future studies should provide detailed DD eligibility criteria, and use a standard set of outcomes. Systematic review registration number: 120779, date of first registration: 12/02/2019.

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Section: Summary Of Evidencementioning

confidence: 99%

Direct discharge of patients with simple stable musculoskeletal injuries as an alternative to routine follow-up: a systematic review of the current literature

Geerdink

Verbist

Dongen

et al. 2021

Eur J Trauma Emerg Surg

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“…A statistically significant decrease in average X-rays was observed for isolated stable fracture patterns, such as non-displaced distal radius and Weber A ankle fractures. The natural history of these common fractures is well understood; they are highly unlikely to displace over time and have been shown to be safely managed via virtual fracture clinics [ 12 , 13 , 15 ]. Though suggestive, a statistically significant reduction was not demonstrated for more complex fracture patterns such as Weber B ankle and dorsally displaced distal radius fractures for which follow up imaging is often required.…”

Section: Discussionmentioning

confidence: 99%

“…Ankle sprains and Weber A ankle fractures have established evidence to be treated conservatively in a walking orthosis [ 16 ] and are suitable for virtual clinic management [ 15 ]. Bellringer et al’s study of 309 radiologically stable isolated Weber B ankle fractures, demonstrated that they could be safely managed virtually, with 99.4% (307/309) achieving bony union using a standardised VFC management protocol that involves early full weight bearing in a supportive orthotic from first presentation in the ED, including 11 who were identified and proceeded to surgery.…”

Section: Discussionmentioning

confidence: 99%

Virtual fracture clinic reduces patient X-ray volume for common wrist and ankle fractures

et al. 2021

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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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“…Fifty-nine articles met the inclusion criteria and were considered for the analysis. 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 The excluded thirty-four papers were editorials, letters, duplicate entries, and articles with no discussion on telemedicine even in the full text ( Figure 1 ). The monthly contributions trend of the orthopaedic telemedicine-related articles is shown in Figure 2 .…”

Section: Resultsmentioning

confidence: 99%

“…At the same time, the authors raised concerns regarding inadequate physical examination, lack of proper supervised fracture care, improper brace application, deviation from treatment protocol and resulting complications, and limited application in moderate to severe disease patterns. 59 , 60 , 61 …”

Section: Discussionmentioning

confidence: 99%

Telemedicine trends in orthopaedics and trauma during the COVID-19 pandemic: A bibliometric analysis and review

Kumar

Sinha

Jameel

et al. 2022

Journal of Taibah University Medical Sciences

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Objectives In the wake of recent widespread interest in telemedicine during the COVID-19 era, many orthopaedic surgeons may be unfamiliar with clinical examination skills, patients’ safety, data security, and implementation-related concerns in telemedicine. We present a bibliometric analysis and review of the telemedicine-related publications concerning orthopaedics care during the COVID-19 pandemic. Such analysis can help orthopaedic surgeons become acquainted with the recent developments in telemedicine and its usage in regular orthopaedics practice. Methods We systematically searched the database of Thomson Reuters Web of Science for telemedicine-related articles in orthopaedics published during the COVID-19 pandemic. The selected articles were analysed for their source journals, corresponding authors, investigating institutions, countries of the corresponding authors, number of citations, study types, levels of evidence, and qualitative review. Results Fifty-nine articles meeting the inclusion criteria were published in 28 journals. Three hundred forty-two authors contributed to these research papers. The United States (US) contributed the most number of articles to the telemedicine-related orthopaedics research during the COVID-19 era. All articles combined had a total of 383 citations and 66.1% were related to the Economic and Decision-making Analyses of telemedicine implementation. By and large, level IV evidence was predominant in our review. Conclusion Telemedicine can satisfactorily cover a major proportion of patients' visits to outpatient departments, thus limiting hospitals’ physical workload. Telemedicine has a potential future role in emergency orthopaedics and inpatient care through virtual aids. The issues related to patient privacy, data security, medicolegal, and reimbursement-related aspects need to be addressed through precise national or regional guidelines. Lastly, the orthopaedic physical examination is a weak link in telemedicine and needs to be strengthened.

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Virtual Fracture Clinics in Orthopaedic Surgery - A Systematic Review of Current Evidence

Cited by 26 publications

References 32 publications

Direct discharge of patients with simple stable musculoskeletal injuries as an alternative to routine follow-up: a systematic review of the current literature

Direct discharge of patients with simple stable musculoskeletal injuries as an alternative to routine follow-up: a systematic review of the current literature

Virtual fracture clinic reduces patient X-ray volume for common wrist and ankle fractures

Telemedicine trends in orthopaedics and trauma during the COVID-19 pandemic: A bibliometric analysis and review

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