Brogan Kit, Bellringer Simon, Akehurst Harold, Gee Christopher, Ibrahim Nada, Cassidy Lucy, Rogers Ben, Gibbs James
Royal Sussex County Hospital, Brighton, East Sussex, BN25BE, United Kingdom.
Royal Sussex County Hospital, Brighton, East Sussex, BN25BE, United Kingdom.
Injury. 2017 Apr;48(4):966-970. doi: 10.1016/j.injury.2017.02.003. Epub 2017 Feb 12.
Virtual clinics have been shown to be safe and cost-effective in many specialties, yet barriers exist to their implementation in orthopaedics. The aims of this study were to look at whether the management of 5th metatarsal fractures using a virtual fracture clinic model is safe, cost effective and avoids adverse outcomes whilst being acceptable to patients using the service. All patients with a fifth metatarsal fracture between September 2013 and September 2015 had a standardised management plan initiated (blackboot, full weightbearing) in the emergency department (ED). 663 patients met inclusion criteria, 251 (37.5%) Type 1, 111 (17%) Type 2 (Jones'), 281 (42%) Type 3 or distal, 20 (3%) were misdiagnosed, and 4 (0.5%) patient's images were unavailable. 499 (75%) patients were discharged immediately, 47 (7%) had further imaging, 114 (17%) had either ESP or consultant clinic review, and 3 (<1%) transferred their care privately. The average number of clinic visits per patient was 0.17. At a conservative estimate of 1.3 visits per patient in a traditional pathway this saved 779 clinic visits with a cost saving of £60,000 on clinic visits alone. There were 8 (7%) asymptomatic non-unions in Type 2 (Jones') fractures. One patient required surgical intervention. Fifth metatarsal fractures have excellent outcomes with conservative management yet traditionally have required clinic visits to confirm the diagnosis and explain the management and prognosis. Our study supports the use of a virtual fracture clinic model that is standardised, initiated in ED, that is both safe and cost-effective.
虚拟诊所已被证明在许多专科领域是安全且具有成本效益的，但在骨科实施过程中仍存在障碍。本研究的目的是探讨使用虚拟骨折诊所模式管理第五跖骨骨折是否安全、具有成本效益，能否避免不良后果，同时让使用该服务的患者可以接受。2013年9月至2015年9月期间所有第五跖骨骨折患者在急诊科启动了标准化管理计划（黑色靴子方案，完全负重）。663例患者符合纳入标准，其中251例（37.5%）为1型，111例（17%）为2型（琼斯骨折），281例（42%）为3型或远端骨折，20例（3%）被误诊，4例（0.5%）患者的影像资料缺失。499例（75%）患者立即出院，47例（7%）进行了进一步影像学检查，114例（17%）接受了急诊手术或专家门诊复查，3例（<1%）患者私下转诊。每位患者的平均门诊就诊次数为0.17次。保守估计，传统诊疗路径下每位患者需就诊1.3次，仅此一项就节省了779次门诊就诊，节省门诊费用60,000英镑。2型（琼斯骨折）骨折中有8例（7%）出现无症状骨不连。1例患者需要手术干预。第五跖骨骨折采用保守治疗效果良好，但传统上需要门诊就诊以确诊并解释治疗方案和预后。我们的研究支持使用在急诊科启动的标准化虚拟骨折诊所模式，该模式既安全又具有成本效益。
