Standardised virtual fracture clinic management of radiographically stable Weber B ankle fractures is safe, cost effective and reproducible

Injury. 2017 Jul;48(7):1670-1673. doi: 10.1016/j.injury.2017.04.053. Epub 2017 Apr 26.

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.

Keywords: Ankle; Trauma; Virtual fracture clinic; Weber B.

MeSH terms

  • Ankle Fractures* / economics
  • Ankle Fractures* / physiopathology
  • Ankle Fractures* / rehabilitation
  • Ankle Fractures* / surgery
  • Clinical Audit
  • Cost-Benefit Analysis
  • Evidence-Based Practice
  • Female
  • Fracture Fixation, Internal*
  • Humans
  • Male
  • Middle Aged
  • Patient Satisfaction
  • Radiography*
  • Reproducibility of Results
  • Retrospective Studies
  • Telemedicine / economics*
  • Telemedicine / standards*
  • Treatment Outcome
  • United Kingdom
  • User-Computer Interface
  • Weight-Bearing