S F Bellringer1, K Brogan2, L Cassidy3, J Gibbs3. 1. Brighton and Sussex University Hospital NHS Trust, United Kingdom. Electronic address: simon.bellringer@bsuh.nhs.uk. 2. St George's University Hospitals NHS Foundation Trust, United Kingdom. 3. Brighton and Sussex University Hospital NHS Trust, United Kingdom.
Abstract
BACKGROUND: Virtual clinics have been shown to be safe and cost-effective in many specialties, yet barriers exist to their implementation in orthopaedics. Ankle fractures are common and therefore represent a significant clinical workload. The aim of this study was to evaluate the management of radiographically stable Weber B ankle fractures using a standardised treatment protocol in a virtual fracture clinic setting, to assess clinical outcomes, any complications and its cost effectiveness. METHODS: All patients referred to the VFC with an actual or suspected stable Weber B ankle fracture between September 2013 and September 2015 were identified. The primary outcome measure was successful fracture union. Any complications were noted and a cost analysis comparing the VFC and traditional fracture clinic models was undertaken. RESULTS: 314 patients referred with a radiographically stable Weber B ankle fracture were identified. Follow up was complete for 98.4% (309/314) of patients. The union rate was 99.4% (307/309) in patients where follow up was completed. 3.5% (11/309) of patients were underwent acute surgical intervention. Of these patients, 6 were identified as having an unstable injury on weight bearing radiographs at 2 weeks and underwent ORIF, 4 were identified as having an unstable injury on EUA and underwent ORIF and 1 had an EUA with no fixation. 2 patients required ORIF for radiographically confirmed non-union. A cost saving analysis comparing the traditional fracture clinic model and VFC model revealed a saving of £237 per patient (32% reduction) with a VFC model. This represents an estimated saving of almost £40,000 per year for the management of this injury alone in our institution. CONCLUSION: Our study supports the use of a virtual fracture clinic model that is standardised, initiated in ED, and is both safe and cost-effective in the management of radiographically stable Weber B ankle fractures. LEVEL OF EVIDENCE: Level III-Retrospective Cohort Study.
BACKGROUND: Virtual clinics have been shown to be safe and cost-effective in many specialties, yet barriers exist to their implementation in orthopaedics. Ankle fractures are common and therefore represent a significant clinical workload. The aim of this study was to evaluate the management of radiographically stable Weber B ankle fractures using a standardised treatment protocol in a virtual fracture clinic setting, to assess clinical outcomes, any complications and its cost effectiveness. METHODS: All patients referred to the VFC with an actual or suspected stable Weber B ankle fracture between September 2013 and September 2015 were identified. The primary outcome measure was successful fracture union. Any complications were noted and a cost analysis comparing the VFC and traditional fracture clinic models was undertaken. RESULTS: 314 patients referred with a radiographically stable Weber B ankle fracture were identified. Follow up was complete for 98.4% (309/314) of patients. The union rate was 99.4% (307/309) in patients where follow up was completed. 3.5% (11/309) of patients were underwent acute surgical intervention. Of these patients, 6 were identified as having an unstable injury on weight bearing radiographs at 2 weeks and underwent ORIF, 4 were identified as having an unstable injury on EUA and underwent ORIF and 1 had an EUA with no fixation. 2 patients required ORIF for radiographically confirmed non-union. A cost saving analysis comparing the traditional fracture clinic model and VFC model revealed a saving of £237 per patient (32% reduction) with a VFC model. This represents an estimated saving of almost £40,000 per year for the management of this injury alone in our institution. CONCLUSION: Our study supports the use of a virtual fracture clinic model that is standardised, initiated in ED, and is both safe and cost-effective in the management of radiographically stable Weber B ankle fractures. LEVEL OF EVIDENCE: Level III-Retrospective Cohort Study.
Authors: Zhan H Ng; Samantha Downie; Navnit S Makaram; Shivam N Kolhe; Samuel P Mackenzie; Nicholas D Clement; Andrew D Duckworth; Timothy O White Journal: Bone Jt Open Date: 2021-03
Authors: Conor S O'Driscoll; Andrew J Hughes; Fergus J McCabe; Elaine Hughes; John F Quinlan; Brendan J O'Daly Journal: Ir J Med Sci Date: 2021-10-16 Impact factor: 2.089
Authors: Evelyn P Murphy; Christopher Fenelon; Robert P Murphy; Michael D O'Sullivan; Eoghan Pomeroy; Eoin Sheehan; David P Moore Journal: Clin Orthop Relat Res Date: 2020-11 Impact factor: 4.755