Standardised virtual fracture clinic management of Achilles tendon ruptures is safe and reproducible

Robertson, Alastair; Godavitarne, Charles; Bellringer, Simon; Guryel, Enis; Auld, Felicity; Cassidy, Lucy; Gibbs, James

doi:10.1016/j.fas.2018.10.010

Cited by 9 publications

(10 citation statements)

References 19 publications

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“…Additionally, standardized virtual management of acute Achilles’ tendon rupture has been shown to be safe and reproducible, with re-rupture rates comparable to those managed in person. 71 Despite not being specific to the pediatric population, the evidence highlighted above can increase providers’ confidence when performing a virtual foot and ankle exam.…”

Section: Ankle and Footmentioning

confidence: 99%

The Telemedicine-Based Pediatric Examination of the Back and Lower Limbs: A Narrative Review

Noutsios

Boisvert-Plante

Laberge

et al. 2021

JPR

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The COVID-19 pandemic has accelerated the transition to virtual healthcare while also prompting an abundance of new literature highlighting telemedicine’s capabilities and limitations for various medical applications, notably musculoskeletal examinations. Telemedicine provides an opportunity to deliver timely patient- and family-centred care while maintaining physical distancing and improving access to remote communities. This review aims to narrate the current state of the literature on telemedicine applied in the context of a musculoskeletal examination for children aged 3 to 18 years. The PubMed and ScienceDirect databases were searched for relevant articles from January 2015 to August 2021 using a combination of keywords and nested searches. The general examination components relevant to the back and lumbosacral spine, hip, knee, ankle/foot, and gait are described. These components include inspection, palpation, range of motion, motor, and sensory examination as well as special testing. There is general feasibility, validity, and substantial reliability in performing most examination components, and primary diagnoses established virtually were found to be either the same or similar in the vast majority of cases. Despite the current literature focusing mainly on adult populations, we describe how each aspect of the exam can be reliably incorporated into a virtual appointment specific to the pediatric population. Currently available smartphone-based applications that measure joint range of motion were generally found to have high reliability and validity. Caregivers are needed for most of the consultation, especially in younger children, but select physical exam maneuvers can be self-performed by older children and adolescents alone. By providing an overview of the available smartphone tools as well as the reliability and validity of remote assessments, this review not only establishes a foundation for a structured pediatric musculoskeletal examination, but also aims to increase providers’ confidence in incorporating telemedicine into their practice.

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Section: Ankle and Footmentioning

confidence: 99%

The Telemedicine-Based Pediatric Examination of the Back and Lower Limbs: A Narrative Review

Noutsios

Boisvert-Plante

Laberge

et al. 2021

JPR

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“…Four studies had an exclusively adult cohort [2,11,14,26], two had an exclusively pediatric cohort [27,30], and eight had a mixed cohort [3,5,8,13,17,19,20,23]. Ten studies reported on multiple injuries [5,11,14,17,19,20,23,27,33,34], seven reported on single injuries [2,3,8,13,15,26,30], and one did not specify [21] (Table 1). Only four studies included a comparison group with a traditional fracture clinic [13,20,21,30].…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Seventeen of 18 included studies stated in their conclusions that the virtual fracture clinic was a safe model of care; however, these studies did not state how safety was defined. Ten studies discussed further operations, which were required during the course of the treatment [2,3,8,11,13,14,15,20,26,27]. These were included to demonstrate that further operations will occur and to highlight the expected frequencies (Table 3).…”

Section: Adverse Outcomes Of the Virtual Fracture Clinic Modelmentioning

confidence: 99%

Are Virtual Fracture Clinics During the COVID-19 Pandemic a Potential Alternative for Delivering Fracture Care? A Systematic Review

Murphy

Fenelon

Murphy

et al. 2020

Clin Orthop Relat Res

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Background Virtual fracture clinics are an alternative to the traditional model of fracture care. Since their introduction in 2011, they have become increasingly used in the United Kingdom and Ireland. The coronavirus disease 2019 (COVID-19) health crisis has driven institutions to examine such innovative solutions to manage patient care. The current controversies include quantifying safety outcomes, such as potential delayed or missed injuries, inadequate treatment, and medicolegal claims. Questions also exist regarding the potential for cost reductions and efficiencies that may be achieved. Physical distancing has limited the number of face-to-face consultations, so this review was conducted to determine if virtual fracture clinics can provide an acceptable alternative in these challenging times. Questions/purposes The aim of this systematic review was to describe (1) adverse outcomes, (2) cost reductions, and (3) efficiencies associated with the virtual fracture clinic model. Methods A systematic review of the PubMed, MEDLINE, and Embase databases was conducted from database inception to March 2020. The keywords “virtual” or “telemedicine” or “telehealth” or “remote” or “electronic” AND “fracture” or “trauma” or “triage” AND “clinic” or “consultation” were entered, using the preferred reporting items for systematic reviews and meta-analyses. Inclusion criteria included adults and children treated for injuries by a virtual clinic model at the initial review. Eligible injuries included injuries deemed to not need surgical intervention, and those able to be treated remotely using defined protocols. Exclusion criteria consisted of patients reviewed by telemedicine using video links or in person at the initial review. Initially, 1065 articles were identified, with 665 excluded as they did not relate to virtual fracture clinics. In all, 400 articles were screened for eligibility, and 27 full-text reviews were conducted on 18 studies (30,512 virtual fracture clinic encounters). Three subdomains focusing on adverse outcomes, cost reductions, and efficiencies were recorded. The term adverse outcomes was used to describe any complications, further surgeries, re-referrals back to the clinic, or deviations from the protocols. Efficiency described the number of patients reviewed and discharged using the model, savings in clinic slots, reduced waiting times, or a reduction in consumption of resources such as radiographs. All studies were observational and the quality was assessed using Newcastle-Ottawa tool, which demonstrated a median score of 6 ± 1.8, indicating moderate quality. Results Six studies reported adverse outcomes in detail, with events ranging from inappropriate splinting, deviations from protocols, and one patient underwent an osteotomy for a malunion. Efficiency varied from direct discharge proportions of 18% in early studies to 100% once the virtual fracture clinic model was more established. Cost reductions compared with estimates derived from conventional fracture clinics varied from USD 53 to USD 297 and USD 39,125 to USD 305876 compared with traditional fracture clinic visits. Conclusions Virtual fracture clinics may provide a means to treat patients remotely, using agreed-upon protocols. They have an important role in the current COVID-19 pandemic, due to the possibility to provide ongoing care in an otherwise challenging setting. More robust studies looking at this model of care will be needed to assess its long-term effects on patients, institutions, and health care systems. Level of Evidence Level IV, therapeutic study.

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“…Across the country, virtual fracture clinics have been gradually increasing and have been shown to improve both clinical and cost-effectiveness [22]. Some trusts have incorporated virtual clinics for specific injuries such as Achilles tendon injuries and wrist and hand injuries [23,24].…”

Section: Benefitsmentioning

confidence: 99%

Getting it Right First Time in Trauma Clinic: How a Pandemic Improved Service Provision for Orthopaedic Patients

2023

MCR

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Introduction: The 2019 coronavirus outbreak (COVID-19) fast became a global pandemic. In the United Kingdom, guidlines were introduced to help control the spread of this virus. Hospitals made significant changes to accommodate for the change in demand. Orthopaedic trauma services needed to remain, however, the management of orthopaedic trauma needed modifying to comply with government and hospital guidelines. Method: Queens’s hospital, Burton, is a level III trauma unit. The orthopaedic department manages upper and lower limb trauma as well as head and chest and spine trauma. Injured patients can be referred to the orthopaedic team from the community or from the Major and Minor Emergency Department. To accommodate new guidelines, the orthopaedic department introduced a ‘virtual clinic’ and a ‘trauma clinic’. The virtual clinic took place in the morning and discussed referrals from the day before. The ‘trauma clinic’ followed on from the virtual clinic and lasted the remainder of the day. Results: The intervention introduced to Queens’s hospital was beneficial for patients, staff and for the hospital. It improved waiting times, reduced the time patients spent in hospital, reduced the number of hospital attendees and enhanced knowledge of common orthopaedic injuries for staffing involved in reviewing and managing these injuries. Conclusion: For our department, these changes improved service provision, staff education and patient safety. These benefits could be seen in other trusts if a similar method of managing trauma patients was introduced.

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Standardised virtual fracture clinic management of Achilles tendon ruptures is safe and reproducible

Cited by 9 publications

References 19 publications

The Telemedicine-Based Pediatric Examination of the Back and Lower Limbs: A Narrative Review

The Telemedicine-Based Pediatric Examination of the Back and Lower Limbs: A Narrative Review

Are Virtual Fracture Clinics During the COVID-19 Pandemic a Potential Alternative for Delivering Fracture Care? A Systematic Review

Getting it Right First Time in Trauma Clinic: How a Pandemic Improved Service Provision for Orthopaedic Patients

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