Virtual Fracture Research Articles

Efficiency of a virtual fracture clinic review protocol in adult patients with distal radial fractures requiring semi-acute surgical treatment

PurposeThe aim of this study was to evaluate the effect of implementation of a Virtual Fracture Clinic (VFC) review protocol on the time between injury and surgery, and on secondary healthcare utilization, in patients with Distal Radius Fractures (DRFs) requiring semi-acute surgery.MethodsData for this retrospective before-after study were gathered between April 2017 and March 2019 (Pre-VFC n = 269), and between April 2021 and March 2023 (VFC n = 440) in a large level 2 urban trauma center. The primary outcome was the number of days between injury and operation. Furthermore secondary healthcare utilization was assessed.ResultsThe average time between injury and surgery was 11.0 days (95% CI: 10.6–11.5) before and 9.2 days (95% CI: 8.9–9.6) after VFC-implementation ( p < 0.001). Following VFC-implementation, 33% (was 17%) of patients underwent surgery within 7 days, 92% (was 84%) within 2 weeks, and 99% (was 96%) within 3 weeks (p < 0.001). This included patients with delays of up to 15 days between injury and their initial hospital presentation. Hospital contacts decreased from 5 (IQR: 4–6) to 4 (IQR: 3–5) whereof physical consults decreased from 4 (IQR: 3–5) to 1 and telephone contacts increased from negligible to 1 (IQR: 1–2). Radiographs reduced from 6 (IQR: 5–7) to 4 (IQR: 3–5).ConclusionsImplementation of a VFC-review protocol is associated with a reduced time between injury and semi-acute surgery for DRFs and reflects an improvement in quality of timely planning. Secondary healthcare utilization is reduced and a shift to remote delivery of care is observed.Level of evidenceLevel III.

Accuracy analysis of the digital occlusal relationship reconstruction workflow in patients with maxillofacial fractures: An in vitro retrospective cohort study.

To verify the accuracy of a digital workflow for occlusal relationship reduction in patients with maxillofacial fractures via cone beam computed tomograhy/ computerized tomography (CBCT/CT). We collected CBCT/CT data and oral scan data from both general patients and fracture patients and established digital models. The differences between the oral scan model and the CBCT/CT digital model were compared. 3D-printed dental models were made for general patients, and comparisons were made matching the dental model with the original occlusion. Differences among the postoperative CT digital models of fracture patients, the virtual reconstruction models, and the model surgery reconstructed models were compared. A total of 20 general patients and 27 fracture patients participated in this study. The average error for the segmented CBCT/CT modelling group was 122.90±26.94 μm, whereas the average error for the nonsegmented CBCT/CT modelling group was 84.50±9.21 μm, with a significant difference between the two groups (t = 6.364, P < 0.01). The error in the occlusal relationship between the 3D-printed models and the patient's actual occlusion was 18.35±2.20 μm. The average error for the virtual reconstruction group was 438.89±155.55 μm, whereas it was 857.09±116.55 μm for the model surgery reconstruction group, with a significant difference between the two groups (t = 11.180, P < 0.01). CBCT/CT-based digital dental models can be created with high accuracy. Using 3D-printed models and intercuspal occlusion guidance, the original occlusal relationship can be restored. Compared with model surgery, virtual fracture reconstruction offers superior accuracy. This study demonstrates the feasibility of accurate digital occlusal restoration in fracture patients, providing a new approach for maxillofacial fracture management.

Virtual surgical planning in tripod zygomatico-maxillary complex fractures: A prospective comparison between two different strategies

Multifragmentary and displaced zygomaticomaxillary complex (ZMC) fractures are often a challenge for the maxillofacial surgeon. The aim of this study was to evaluate the improved performance in the management of patients with tripod fracture of the orbito-zygomaticomaxillary complex, using two different methods of virtual surgical planning — virtual reduction and mirroring — compared with traditional management. A cohort of 60 patients was selected and divided into three groups, each consisting of 20 individuals. Patients in the first group were managed using the virtual reduction method, those in the second group using the mirroring method, and those in the third group using a traditional surgical approach. Having achieved virtual fracture reduction, a stereolithographic model was printed, on which preplating of the plates was performed. The results showed that virtual reduction was the most accurate in absolute terms, with a mean discrepancy in juxtaposition of the preoperative and postoperative CT images of 0.175 mm (SD ± 0.147), compared with 0.403 (SD ± 0.166) for the mirror method (and traditional method (0.875, SD ± 0.112; p > 0.0001). The average surgical time for virtual reduction (89.5 min) was faster than for mirroring (94.25 min) and for the traditional approach (96.75 min). In conclusion, the use of virtual surgical planning allows greater intraoperative accuracy, reduced surgical time, and reduced postoperative complications compared with traditional surgery. Of the two methods, virtual reduction performed best for the outcomes decribed.

Multiscale evaluation of virtual fractures induced by direct current electric fields in multiple scenarios

Faced with dwindling fossil fuel reserves, enhancing energy recovery and transitioning to renewables is essential. In tight reservoirs, electrochemical effects of micro and nanopores obstruct fluid movement, the miscibility pressures of CO2 and oil, and the fluid heat extraction efficiency. This study introduces a method utilizing direct current (DC) electric fields to enhance energy development, showcasing its potential from microscale experiments to macroscale applications. Based on microfluidic and electro-driven displacement experiments, the concept of virtual fractures is proposed and a corresponding model is developed. Numerical simulations further clarify the impact of virtual fractures on CO2 recovery, storage, and thermal extraction, proposing a workflow for effective implementation. Using the Non-Sorting Genetic Algorithm II (NSGA-II) for optimization. Results of the systematic performance analysis show that an electric field strength of 0.5V/m optimally enhances CO2 recovery rates, comparable to miscible extractions. The technology fosters secondary and primary virtual fractures, enhancing the efficiency of energy extraction systems. Economic analyses confirm the feasibility of this DC-assisted strategy. Compared to conventional schemes, the optimized schemes offer greater economic benefits, amounting to 4.982 and 3.052 million US dollars, respectively. In summary, multiscale experiments, numerical simulations, and economic analyses underscore the advantages of DC electric field-assisted energy extraction.

Evaluating the Effectiveness of Virtual Fracture Clinics in Managing Toe Fractures: Patient Demographics and Outcomes.

Background Virtual fracture clinics (VFCs) offer a remote alternative to traditional fracture clinics, potentially reducing the burden on in-person services. This is particularly relevant for fractures that typically do not require follow-up, such as toe fractures, which are commonly managed conservatively. Methods This study evaluated the effectiveness of VFCs in managing toe fractures. Patients treated conservatively were identified using HIVE software, and their outcomes were assessed via a telephone survey. The survey included the Foot and Ankle Ability Measure (FAAM) and additional questions about their recovery process. Results Among 56 respondents (62.5% male, median age 26.0 years), the majority sustained injuries to the right foot (62.5%), great toe (71.4%), and proximal phalanx (67.9%). Patient satisfaction was high, with 92.9% reporting a positive experience and 98.2% finding the advice provided helpful. Median FAAM scores were 100% across both subscales, with a median recovery time of 6.0 weeks. Despite high satisfaction and favorable clinical outcomes, factors such as female gender and increased age were linked to poorer outcomes. Conclusion VFCs demonstrate high patient satisfaction, positive clinical outcomes, and cost-efficiency, making them a viable alternative to traditional fracture clinics, particularly for conservatively managed fractures. Further research should involve larger sample sizes, prospective study designs, and control groups to validate these findings.

Simulation method of asphalt mixture based on fracturable digital aggregate model

This study proposed an approach to construct a fracturable aggregate model to make the fracture patterns consistent with the real situation. Firstly, this study utilized three-dimensional structured light technology to obtain the geometric shell of aggregate and divide them into four categories of spherical, angular, elongated and flaky aggregates according to the minimum bounding box algorithm. Secondly, this study proposed a discrete-spheres filling algorithm based on the Bubble Pack Filling algorithm to fill the shell accurately. Thirdly, this study established the conversion equations between the macro and micro parameters of aggregate by using the linear parallel bonding model, and used it to establish the fracturable aggregate model. Through the indoor and virtual static fracture tests, this study found that the fracture patterns of the fracturable aggregate models are similar to the real situation and characterized the fracture patterns of four types of aggregates. Further analyzing the virtual static fracture tests, this study found that the bearing capacity of aggregates is determined by the compressive strength of host rocks and the shape of aggregate. Through the indoor and virtual uniaxial compression creep tests, this study investigated the behavior of the mixture specimens consisted by the fracturable aggregate model. The stress-strain curves of the fracturable and unfracturable aggregate model in this test were plotted in this study, and the results showed that the relative error between the results obtained by the fracturable model and those of the indoor test is much smaller than that of the unfracturable model. Considering that existing simulation tests on asphalt mixture often ignore aggregate deformation and fracture, so this study used the method mentioned above to obtain the fracturable aggregate model, which can improve the confidence of asphalt mixture simulation results.

A mixed-method review of the efficacy of a virtual fracture clinic: an 8-year follow up

Background: Virtual fracture clinics are well established methods of managing trauma patients safely and effectively. While they have been widely adopted, there is a lack of research on their longer-term implementation and success. Aims: This paper aimed to review factors that may influence the success of a virtual fracture clinic. Methods: Business analytics were used to calculate clinic discharge and return rates, as well as the reasons for them. Qualitative analysis was used to look at patient satisfaction with virtual consultations; data were extracted from two differing time points via telephone interviews. Results: The mean discharge rate across the 2014–2021 period was 28%. The largest discharge rate was seen in 2014 (43%) and the lowest was seen in 2021 (28%). Return rates to the emergency department at the two different time points were 2% and 0.9% respectively. Patient satisfaction was rated as ‘good’ or higher in all parameters at both time points. Discussion: This article describes the long-term success of a virtual fracture clinic. Results demonstrate excellent patient satisfaction coupled with the lowest return rates in the published literature. Discharge rates started extremely high and have declined with time. The factors for these results are discussed along with ideas for further prospective research.

Is the Diagnosis of fifth Metatarsal Fracture Type Consistent? An Interobserver Reliability Study.

Treatment pathways of fifth metatarsal fractures are commonly directed based on fracture classification, with particular proximal fractures typically requiring closer observation and possibly more aggressive management. Our aim is to investigate the interobserver reliability of assessment of subtypes of fifth metatarsal fractures. We included all patients referred to our virtual fracture clinic with a suspected or confirmed fifth metatarsal fracture. Plain anteroposterior radiographs were reviewed by 2 novice observers, initially trained on the fifth metatarsal classification identification. Eight different zones were defined based on anatomical location. Patients were excluded from analysis if neither observer could identify a fracture. An interobserver reliability analysis using Cohen κ coefficient was carried out, and degree of observer agreement described using Landis and Koch's description. All data were analyzed using IBM SPSS, version 27. A total of 1360 patients who met the inclusion criteria were identified. The 2 observers had moderate agreement when identifying fractures in all zones, apart from zone 1.2 and distal metaphysis (DM) fractures, which only achieved fair agreement (κ = 0.308 and 0.381 respectively). Zone 3 has slight agreement with zone 2 proximally, and there is an apparent difficulty with distal diaphyseal shaft (DS) fractures, resulting in a lot of crossover with DM, achieving a fair level of agreement (DS 312 vs 196; DM 120 vs 237; κ = .398, P < .001). Reliability of subcategorizing fifth metatarsal fractures using standardized instructions conveys moderate agreement in most cases. If the region of the fracture is going to be used in an algorithm to guide a management plan and clinical follow-up during a virtual clinic review, defining fractures of zones 1-3 needs careful consideration. Level III, retrospective cohort study.

757 Rapid Deployment of a Virtual Fracture Clinic (VFC) at a London District General Hospital: Safely Building on a Pragmatic Measure to Bring About Lasting Service Impact

757 Rapid Deployment of a Virtual Fracture Clinic (VFC) at a London District General Hospital: Safely Building on a Pragmatic Measure to Bring About Lasting Service Impact

Advancing orthopaedic trauma care through WhatsApp: An analysis of clinical and non-clinical applications, challenges, and future directions.

The integration of WhatsApp, a widely-used instant messaging application (IMA), into the realm of orthopaedics and trauma surgery has emerged as a significant development in recent years. This paper explores the multifaceted role of WhatsApp in orthopaedics, focusing on its clinical and non-clinical applications, advantages, disadvantages, and future prospects. The study synthesizes findings from various research papers, emphasizing the growing reliance on mobile technology in healthcare. WhatsApp's role in orthopaedics is notable for its ease of use, real-time communication, and accessibility. Clinically, it facilitates triage, teleconsultation, diagnosis, treatment, patient advice, and post-operative monitoring. Non-clinically, it supports telemedicine, teleradiology, virtual fracture clinics, research, and education in orthopaedic surgery. The application has proven beneficial in enhancing communication among healthcare teams, providing quick responses, and motivating junior physicians. Its use in educational settings has been shown to improve learner's understanding and patient care. However, the use of WhatsApp in orthopaedics is not without challenges. Risks include the potential spread of misleading information, privacy concerns, and issues with image quality affecting diagnosis and treatment decisions. The paper acknowledges the importance of maintaining professional boundaries and the need for oversight measures to ensure content accuracy. Looking forward, the potential of WhatsApp and similar IMAs in orthopaedics lies in their ability to streamline data collection and retrieval, improve doctor-patient communication, and address challenges like bureaucratic red tape and limited resources. The paper suggests that future orthopaedic practice, particularly in emergency departments, will increasingly rely on such technologies for efficient patient management. This shift, however, must be approached with an understanding of the ethical, legal, and practical implications of integrating social media and mobile technology in healthcare.

The effects of a Virtual Fracture Care review protocol on secondary healthcare utilization in trauma patients requiring semi-acute surgery: a retrospective cohort study.

The demand for trauma care in the Netherlands is increasing due to a rising incidence of injuries. To provide adequate trauma care amidst this increasing pressure, a Virtual Fracture Care (VFC) review protocol was introduced for treatment of musculoskeletal injuries to the extremities (MIE). This study aimed to assess the influence of the Dutch VFC review protocol on secondary healthcare utilization (i.e., follow-up appointments and imaging) in adult trauma patients (aged ≥18 years) who underwent semi-acute surgery (2-14 days after initial presentation) for MIE, compared to traditional workflows. We hypothesized utilization of VFC review would lead to reduced secondary healthcare utilization. This retrospective cohort study assessed the influence of VFC review on secondary healthcare utilization in adult trauma patients (aged ≥18 years) who underwent semi-acute surgery for a MIE. Patients treated before VFC review and the COVID-19 pandemic, from 1st of July 2018 to 31st of December 2019, formed a pre-VFC group. Patients treated after VFC review implementation from January 1st 2021 to June 30th 2022, partially during and after the COVID-19 pandemic (including distancing measures), formed a VFC group. Outcomes were follow-up appointments, radiographic imaging, time to surgery, emergency department reattendances, and complications. The study was approved by the local ethical research committee approved this study (WO 23.073). In total, 2,682 patients were included, consisting of 1,277 pre-VFC patients, and 1,405 VFC patients. Following VFC review, the total number of follow-up appointments reduced by 21% and a shift from face-to-face towards telephone consultations occurred with 19% of follow-up appointments performed by telephone in the VFC group vs. 4% in the pre-VFC group. Additionally, VFC review resulted in a 7% reduction of radiographs, improved time scheduling of surgery, and a 56% reduction of emergency department reattendances. Registered complication rates remained similar. The utilization of VFC review for management of adult patients with a MIE requiring semi-acute surgery improves efficiency compared to traditional workflows. It results in a 21% follow-up appointment reduction, a shift from face-to-face to remote delivery of care, fewer radiographs, improved time scheduling of surgery, and reduces emergency department reattendances by 56%.

IS THE DIAGNOSIS OF FIFTH METATARSAL FRACTURE SUBTYPE CONSISTENT? AN INTEROBSERVER RELIABILITY STUDY

IntroductionTreatment pathways of 5th metatarsal fractures are commonly directed based on fracture classification, with Jones types for example, requiring closer observation and possibly more aggressive management.Primary objectiveTo investigate the reliability of assessment of subtypes of 5th metatarsal fractures by different observers.MethodsPatients were identified from our prospectively collected database. We included all patient referred to our virtual fracture clinic with a suspected or confirmed 5th metatarsal fracture. Plain AP radiographs were reviewed by two observers, who were initially trained on the 5th metatarsal classification identification. Zones were defined as Zone 1.1, 1.2, 1.3, 2, 3, diaphyseal shaft (DS), distal metaphysis (DM) and head. An inter-observer reliability analysis using Cohen's Kappa coefficient was carried out, and degree of observer agreement described using Landis &amp; Koch's description. All data was analysed using IBM SPSS v.27.Results878 patients were identified. The two observers had moderate agreement when identifying fractures in all zones, apart from metatarsal head fractures, which scored substantial agreement (K=.614). Zones 1.1 (K=.582), 2 (K=.536), 3 (K=.601) and DS (K=.544) all tended towards but did not achieve substantial agreement. Whilst DS fractures achieved moderate agreement, there was an apparent difficulty with distal DS, resulting in a lot of cross over with DM (DS 210 vs 109; DM 76 vs 161). Slight agreement with the next highest adjacent zone was found when injuries were thought to be in zones 1.2, 1.3 and 2 (K=0.17, 0.115 and 0.152 respectively).ConclusionsReliability of sub-categorising 5th metatarsal fractures using standardised instructions conveys moderate to substantial agreement in most cases. If the region of the fracture is going to be used in an algorithm to guide a management plan and clinical follow up during a virtual clinic review, defining fractures of zones 1–3 needs careful consideration.

Virtual Fracture Clinic Patients' Satisfaction Outcomes.

Background During the COVID-19 pandemic, there was a need to balance optimum treatment service and the safety of patients and hospital staff. The British Orthopaedic Association recommended a virtual fracture clinic to give the right first-time decision and to minimize patient exposure to disease. This study aimed to evaluate the patients' satisfaction outcomes for the service provided through the virtual fracture clinic. Methodology From January to May 2022, all patients seen by the staff in the Emergency Department (ED) at Queens Burton Hospitals were enrolled in a prospective study. An Excel spreadsheet was provided to both ED personnel and the orthopaedic team for accessibility. Patients were continually added to the spreadsheet, and their cases were reviewed by the on-call consultant to devise treatment plans. A satisfaction questionnaire was collected from patients about their virtual clinic experience as a route to provide treatment service. Results The study comprised 150 patients, with an average age of 40 years. Distal radial fractures represented one-third of the cases. Different modalities of management were offered such as a sling, splint, cast, or referral to physiotherapy. Around 75% of cases were satisfied, understood the advice given over the phone, and were not required to attend the actual clinic. The remaining quarter attended the clinic either for further reassessment by an orthopaedic surgeon or for discussion of their injury as they could not get the full message over the phone due to fast calls, hearing struggles, or just listening to messages. Conclusions The virtual fracture clinic is an effective standalone service that gained around 75% satisfaction in patients' outcome questionnaires. It saved the actual fracture clinic slots and hospital resources. It is recommended to be part of the standard daily practice throughout the United Kingdom.

Audit of a Revised Pathway Aimed at Expediting Diagnosis and Treatment for Suspected Achilles Tendon Rupture

Treatment outcomes for Achilles tendon ruptures depend upon prompt diagnosis and management. A local study in 2018 highlighted inefficiencies in patient management, and a revised protocol was introduced allowing investigation and referral to be initiated by other healthcare professionals. This retrospective audit evaluates the impact of this on the timescale from presentation to treatment. It analyzes all suspected Achilles tendon ruptures within one District General Hospital from April 2021 to March 2022. Data regarding patient timelines was compared to the 2018 study. Over 12 months, 99 patients were referred to Virtual Fracture Clinic, 87.8% (n = 87) of which had a complete or partial tear on ultrasound scan (USS). In comparison to 2018, the average time from presentation to USS request reduced from 2.9 to 1.1 days (p < .01). 95% were scanned within one week of USS request and 31.3% within 48 hours (81% and 18%, previously). The average time from USS request to scan went from 6.8 to 3.2 days (p < .01). The time from presentation to treatment decision reduced from 10.9 to 6.2 days (p < .01) and the percentage of patients with a definitive treatment plan within one week increased from 34.5% to 74.2% (p < .01). Patients required 0.8 fewer appointments (p < .01) giving an estimated total saving of $10,110 ($128 per patient) during the analyzed period. The Achilles Tendon Rupture Pathway has significantly improved the proportion of patients undergoing USS within 48 hours and receiving a treatment decision within one week. This study demonstrates an efficient, cost-saving and replicable pathway for Achilles tendon ruptures.

Outcomes of a Novel Spine Virtual Fracture Clinic in an Australian Tertiary Hospital.

This was a retrospective cohort study. To determine the proportion of referrals diverted by the spine virtual fracture clinic (SVFC) from traditional outpatient clinic management. The consistent rise in demand for orthopedic outpatient clinic services is creating marked challenges to the provision of quality care. Virtual fracture clinics for upper and lower limb fractures have reduced the burden on outpatient clinics by providing an alternative telehealth management pathway. To date, no study describes the expansion of virtual care to the spine trauma population. A study of spine fractures referred to the RMH Department of Orthopaedic Surgery was conducted comparing outcomes before (January to December 2021) and following (July 2022 to November 2023) implementation of an SVFC. The primary aim of this study was to investigate the effect of a telephone-based SVFC on outpatient clinic activity, represented by the proportion of referrals discharged without requiring an outpatient clinic appointment. Secondary aims included appointment utilization, lost to follow-up rates, duration of care, missed or misdiagnoses, unplanned operations, and complications. Of the 731 referrals managed by the SVFC, 91.1% were discharged without requiring in-person outpatient clinic attendance. Compared with the outpatient clinic historical cohort (150 referrals), SVFC management was associated with reductions in the average number of consultations per referral (1.8 vs . 2.4, P <0.001), appointments not attended (5% vs . 13%, P <0.001), referrals lost to follow-up (0% vs . 10.7%, P <0.001), and a shorter duration of care (median 48 vs . 58d, P <0.001). A total of 65 patients (8.1%) were redirected to the outpatient clinic, of which three underwent surgical intervention. No diagnostic errors, complications or adverse events were identified. This study demonstrates that an SVFC is an effective and safe alternative pathway to traditional hospital-based outpatient clinics, ith low-risk for any adverse outcomes.

Numerical Simulation Analysis of Control Factors on Acoustic Velocity in Carbonate Reservoirs

The conventional Archie formula struggles with the interpretation of water saturation from resistivity well log data due to the increasing complexity of exploration targets. This challenge has prompted researchers to explore alternative physical parameters, such as acoustic characteristics, for breakthroughs. Clarifying the influencing factors of porous media acoustic characteristics is one of the most important approaches to help understanding the mechanism of acoustic characteristics of carbonate reservoirs. The article uses digital rock technology to characterize the pore structure, quantitatively identify fractures and pore structures in carbonate rocks, and establish digital models. Through conventional acoustic testing, the pressure wave (P-wave) and shear wave (S-wave) velocities of rock samples at different water saturations are obtained, and the dynamic elastic modulus is calculated. A finite element calculation model is established using the digital rock computational model to provide a basis for fluid saturation calculation methods. Based on real digital rock models, different combinations of virtual fractures are constructed, and factors affecting acoustic parameters are analyzed. The study finds that as porosity increases, the velocity difference between porous cores and fractured cores also increases. These findings provide important technical support and a theoretical basis for interpreting acoustic well logging data and evaluating carbonate reservoirs with different pore and fracture types.

The incidence of surgical intervention following a suspected scaphoid fracture.

The underlying natural history of suspected scaphoid fractures (SSFs) is unclear and assumed poor. There is an urgent requirement to develop the literature around SSFs to quantify the actual prevalence of intervention following SSF. Defining the risk of intervention following SSF may influence the need for widespread surveillance and screening of SSF injuries, and could influence medicolegal actions around missed scaphoid fractures. Data on SSF were retrospectively gathered from virtual fracture clinics (VFCs) across a large Scottish Health Board over a four-year period, from 1 January 2018 to 31 December 2021. The Bluespier Electronic Patient Record System identified any surgical procedure being undertaken in relation to a scaphoid injury over the same time period. Isolating patients who underwent surgical intervention for SSF was performed by cross-referencing the unique patient Community Health Index number for patients who underwent these scaphoid procedures with those seen at VFCs for SSF over this four-year period. In total, 1,739 patients were identified as having had a SSF. Five patients (0.28%) underwent early open reduction and internal fixation (ORIF). One patient (0.06%) developed a nonunion and underwent ORIF with bone grafting. All six patients undergoing surgery were male (p = 0.005). The overall rate of intervention following a SSF was 0.35%. The early intervention rate in those undergoing primary MRI was one (0.36%), compared with three in those without (0.27%) (p > 0.576). Surgical intervention was rare following a SSF and was not required in females. A primary MRI policy did not appear to be associated with any change in primary or secondary intervention. These data are the first and largest in recent literature to quantify the prevalence of surgical intervention following a SSF, and may be used to guide surveillance and screening pathways as well as define medicolegal risk involved in missing a true fracture in SSFs.

Functional outcome and risk of non-union for 5th metatarsal base fractures.

Treatment of 5th metatarsal fractures via direct discharge from virtual fracture clinic (VFC) has become common practice in the NHS. We aim to assess the functional outcome and incidence of non-union in a series of 5th metatarsal base fractures, exposed to 1-year of follow-up. 194 patients who sustained a fracture between the period February 2019 to April 2020 were included, referred via the VFC pathway. Radiographs were reviewed to classify in which zone, the fracture occurred along with union on subsequent follow-up. Telephone follow-up was used to measure patient functional outcomes (EQ-5D & FAAM survey) and satisfaction with the VFC service. Off 194 patients, 53 (27.3%) had zone 1, 99 (51%) had zone 2, and 42 (21.6%) had zone 3 fractures. 80 were discharged directly from VFC, with 114 patients being offered at least one face to face clinic follow-up. Six (3.1%) patients had clinical and radiological evidence of non-union; 4 in zone 2, and 2 in zone 3. No zone 1 injuries were identified as a non-union. Only 2 patients had surgery, 1 of which was for symptomatic non-union. Of the 6 non-union patients, 1 had surgery, 4 did not wish to have surgery and the final non-union patient was deemed unsuitable for surgery. The VFC is an effective way of managing 5th metatarsal fractures, with high patient satisfaction. Conservative management has excellent outcomes, with a low percentage of zone 2 and 3 injuries developing a symptomatic non-union. Functional outcome surveys provide further reassurance.

Patient-directed follow-up for the clinical scaphoid fracture

AimsOccult (clinical) injuries represent 15% of all scaphoid fractures, posing significant challenges to the clinician. MRI has been suggested as the gold standard for diagnosis, but remains expensive, time-consuming, and is in high demand. Conventional management with immobilization and serial radiography typically results in multiple follow-up attendances to clinic, radiation exposure, and delays return to work. Suboptimal management can result in significant disability and, frequently, litigation.MethodsWe present a service evaluation report following the introduction of a quality-improvement themed, streamlined, clinical scaphoid pathway. Patients are offered a removable wrist splint with verbal and written instructions to remove it two weeks following injury, for self-assessment. The persistence of pain is the patient’s guide to ‘opt-in’ and to self-refer for a follow-up appointment with a senior emergency physician. On confirmation of ongoing signs of clinical scaphoid injury, an urgent outpatient ‘fast’-wrist protocol MRI scan is ordered, with instructions to maintain wrist immobilization. Patients with positive scan results are referred for specialist orthopaedic assessment via a virtual fracture clinic.ResultsFrom February 2018 to January 2019, there were 442 patients diagnosed as clinical scaphoid fractures. 122 patients (28%) self-referred back to the emergency department at two weeks. Following clinical review, 53 patients were discharged; MRI was booked for 69 patients (16%). Overall, six patients (&lt; 2% of total; 10% of those scanned) had positive scans for a scaphoid fracture. There were no known missed fractures, long-term non-unions or malunions resulting from this pathway. Costs were saved by avoiding face-to-face clinical review and MRI scanning.ConclusionA patient-focused opt-in approach is safe and effective to managing the suspected occult (clinical) scaphoid fracture.Cite this article: Bone Jt Open 2024;5(2):117–122.

RECITAL: a non-inferiority randomised control trial evaluating a virtual fracture clinic compared with in-person care for people with simple fractures (study protocol)

IntroductionMost simple undisplaced fractures can be managed without surgery by immobilising the limb with a splint, prescribing medication for pain, and providing advice and early rehabilitation. Recent systematic reviews based...