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

Bellringer, Simon; Brogan, Kit; Cassidy, Lucy; Gibbs, James

doi:10.1016/j.injury.2017.04.053

Cited by 42 publications

(30 citation statements)

References 10 publications

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“…Consequently, more recent trials on the treatment of SSI's have compared routine follow-up to direct discharge (DD) from the ED without routine follow-up. [7,8,[10][11][12][13][14] Direct discharge is supported by extensive verbal information in the ED, which is summarized in a discharge leaflet and/or smartphone application. [14] Patients are treated in the ED using self-manageable materials such as a brace or pressure bandage.…”

Section: Introductionmentioning

confidence: 99%

Adoption of direct discharge of simple stable injuries amongst (orthopaedic) trauma surgeons

Geerdink

Uijterwijk

Meijer

et al. 2021

Injury

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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Section: Introductionmentioning

confidence: 99%

Adoption of direct discharge of simple stable injuries amongst (orthopaedic) trauma surgeons

Geerdink

Uijterwijk

Meijer

et al. 2021

Injury

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“…Telemedicine poses a signi cant economic bene t with numerous nancial analyses indicating the cost-effectiveness of the modality when compared with conventional visits. (4,5,9,(18)(19)(20) Virtual clinics are not only cost-e cient, but time-e cient for both patients and physicians. Travel and consultation times are decreased, while the utilisation of telemedicine as a triage tool reduces the number of emergency department referrals requiring a face-to-face consult.…”

Section: Discussionmentioning

confidence: 99%

Is Virtual Clinic the Way Forward: Patient Satisfaction Comparing Phone Clinic vs. Conventional Clinic

Wall

Dunnill

et al. 2021

Preprint

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Background:Outpatient clinics play a vital role in assessing and treating patients. They traditionally involve face-to-face consultation with a clinician to diagnose and treat many medical and surgical conditions. During the COVID-19 pandemic many of these traditional methods were replaced with telemedicine to minimise patient interaction and therefore potential exposure. This study utilises data from patient questionnaires with the aim of determining patient satisfaction in regard to telemedicine.Method:A list of patients who attended the Rockingham General hospital outpatient Orthopaedic phone clinic was obtained between 23rd of March and 30th of May, this list was then filtered into a randomised generator to provide a call list of patients. Patients were contacted and verbal consent was obtained to participate in satisfaction questionnaire that was completed via phone.Results: A total of 100 patients completed the questionnaire - 50 from elective surgery clinics and 50 from fracture clinics. The mean time for participants’ one-way commute to the hospital was 21 minutes (2 to 60 minutes). Only 4% of telehealth consultations resulted in patients being forced to miss work or school. 13% of patients were required to attend the hospital on the day of their consultation for either radiological imaging or for application or removal of casts or splint. We observed consistently high satisfaction scores across all parameters, in both elective and fracture clinics, culminating in a mean score of 9.08/10 on the Likert scale. In the qualitative component of the questionnaire, patients frequently acknowledged a high quality of care despite adverse circumstances.Conclusion:Telemedicine continues to develop and become a more widely accessible tool in the provision of outpatient orthopaedic care. With its ever-increasing availability and acceptance, it should play a more central role in delivering effective and efficient healthcare to all patients.

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“…Since they comprised patients who had operative management of ankle fractures, patients who were conservatively managed for Weber A fractures were excluded. 10 However, our study evaluated more complicated Weber B and C fractures that were typically more difficult to classify and had a greater impact on patients' outcomes. Another limitation was recall bias.…”

Section: Discussionmentioning

confidence: 99%

Reliability of Ankle Fracture Classification by Junior Residents and Medical Students in Simulated Clinical Settings

Liau

Phua

et al. 2020

Ann Acad Med Singap

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Ankle fractures are common 1,2 and account for 9% of all fractures 3 with an annual incidence of 174-248 cases per 100,000 adults, 4,5 and their prognostication and management are guided by imaging-based classification systems for ankle fractures. 6 The AO Foundation/Orthopaedic Trauma Association's (AO/OTA) revised classification 7 and Weber classification 8 are commonly used to classify ankle malleolar fractures (Fig. 1). The AO/OTA classification is organised around the location and associated characteristics of the fracture. On the other hand, the Weber classification considers the location of the fibular fracture relative to the syndesmosis. 9 Infra-syndesmotic fractures (Weber A) are stable and managed conservatively, while unstable trans-syndesmotic (Weber B) and supra-syndesmotic (Weber C) fractures are managed surgically. 10 Clinical outcomes differ, with good to excellent outcomes reported in 82.7% and 83.8% of Weber A and B fractures, respectively, compared to 70.4% of Weber C fractures. 5 Operative outcomes also vary, with good to excellent results seen in 95.2%, 94.6% and 80.6% of Weber A, B and C fractures, respectively. 11 Various studies have evaluated the inter-observer reliability and intra-observer reproducibility of both classifications, with kappa values ranging from 0.42-0.86 and 0.34-0.93 for AO/OTA and Weber classifications, respectively, 9,12,13 that corresponded with moderate to substantial agreement. 14 In the busy emergency department and clinic session and examination, clinicians and students have only seconds to examine a radiograph before they advise on the likely management-conservative or surgical-of an ankle fracture, and whether 1 or both tibia and fibula require fixation. In the literature, studies that compared Fig. 1. AO Foundation/Orthopaedic Trauma Association (AO/OTA) and Weber ankle fracture classification systems.

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

Cited by 42 publications

References 10 publications

Adoption of direct discharge of simple stable injuries amongst (orthopaedic) trauma surgeons

Adoption of direct discharge of simple stable injuries amongst (orthopaedic) trauma surgeons

Is Virtual Clinic the Way Forward: Patient Satisfaction Comparing Phone Clinic vs. Conventional Clinic

Reliability of Ankle Fracture Classification by Junior Residents and Medical Students in Simulated Clinical Settings

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