Standardised virtual fracture clinic management of radiographically stable Weber B ankle fractures is safe,cost effective and reproducible |
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| Institution: | 1. Brighton and Sussex University Hospital NHS Trust, United Kingdom;2. St George’s University Hospitals NHS Foundation Trust, United Kingdom;1. Leibniz Universität Hannover, Institute of Mechatronic Systems, 30167 Hannover, Germany;2. Trauma Department, Hannover Medical School, 30625 Hannover, Germany;1. Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, Australia;2. Department of Orthopaedics and Trauma Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland;3. Discipline of Orthopaedics, The University of Adelaide, Adelaide, Australia;1. Department of Pathology, Faculty of Medicine, Urmia University of Medical Sciences, Urmia, Iran;2. Department of Anatomical Sciences, Faculty of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran;3. Solid Tumor Research Center, Urmia University of Medical Sciences, Urmia, Iran;4. Department of Surgery and Diagnostic Imaging, Faculty of Veterinary Medicine, Urmia University, Urmia, Iran |
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| Abstract: | BackgroundVirtual 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.MethodsAll 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.Results314 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.ConclusionOur 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 evidenceLevel III–Retrospective Cohort Study. |
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| Keywords: | Trauma Ankle Weber B Virtual fracture clinic |
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