Bellringer S F, Brogan K, Cassidy L, Gibbs J
Brighton and Sussex University Hospital NHS Trust, United Kingdom.
St George's University Hospitals NHS Foundation Trust, United Kingdom.
Injury. 2017 Jul;48(7):1670-1673. doi: 10.1016/j.injury.2017.04.053. Epub 2017 Apr 26.
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.
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.
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.
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 III-Retrospective Cohort Study.
虚拟诊所已被证明在许多专科中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。踝关节骨折很常见，因此代表了大量的临床工作量。本研究的目的是在虚拟骨折诊所环境中，使用标准化治疗方案评估影像学稳定的Weber B型踝关节骨折的治疗情况，评估临床结果、任何并发症及其成本效益。
确定2013年9月至2015年9月期间转诊至虚拟骨折诊所的所有实际或疑似稳定的Weber B型踝关节骨折患者。主要结局指标是骨折顺利愈合。记录任何并发症，并对虚拟骨折诊所和传统骨折诊所模式进行成本分析。
确定了314例转诊的影像学稳定的Weber B型踝关节骨折患者。98.4%（309/314）的患者完成了随访。完成随访的患者骨折愈合率为99.4%（307/309）。3.5%（11/309）的患者接受了急性手术干预。在这些患者中，6例在2周时负重X线片显示为不稳定损伤并接受切开复位内固定术，4例在关节镜检查时被确定为不稳定损伤并接受切开复位内固定术，1例接受关节镜检查但未进行固定。2例患者因影像学证实骨折不愈合而需要切开复位内固定术。对传统骨折诊所模式和虚拟骨折诊所模式进行的成本节约分析显示，虚拟骨折诊所模式每位患者节省237英镑（减少32%）。仅在我们机构，这就意味着每年仅治疗这种损伤估计可节省近40000英镑。
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，该模式在治疗影像学稳定的Weber B型踝关节骨折方面既安全又具有成本效益。
III级——回顾性队列研究。
