Department of Orthopaedics, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP United Kingdom.
Barts Bone & Joint Health, The Royal London Hospital, Whitechapel Rd, London, E1 1FR United Kingdom.
Injury. 2023 Aug;54(8):110853. doi: 10.1016/j.injury.2023.110853. Epub 2023 Jun 4.
Fracture clinics are experiencing increased referrals and decreased capacity. Virtual fracture clinics (VFC) are an efficient, safe, and cost-effective solution for specified injury presentations. There is currently a lack of evidence to support the use of a VFC model in the management of 5th metatarsal base fractures. This study aims to assess clinical outcomes and patient satisfaction with the management of 5th metatarsal base fractures in VFC. We hypothesise that it is both safe and cost effectiveness.
Patients presenting to VFC at our major trauma centre with a 5th metatarsal base fracture, between January 2019 and December 2019, were included. Patient demographics, clinic appointments, complication and operative rates were analysed. Patients received standardised VFC treatment; walker boot/full weight bearing, rehabilitation information and instructions to contact VFC if symptoms of pain persist after 4 months. Minimum follow-up was one year; Manchester-Oxford Foot Questionnaires (MOXFQ) were distributed. A basic cost analysis was performed.
126 patients met inclusion criteria. Mean age was 41.6 years (18-92). Average time from ED attendance to VFC review was 2 days (1 - 5). Fractures were classified according to the Lawrence and Botte Classification with 104 (82%) zone 1 fractures, 15 (12%) zone 2 fractures and 7 (6%) zone 3 fractures. At VFC, 125/126 were discharged. 12 patients (9.5%) arranged further follow-up after initial discharge; pain the reason in all cases. There was 1 non-union during the study period. Average MOXFQ score post 1 year was 0.4/64, with only 11 patients scoring more than 0. In total, 248 face-to-face clinic visits were saved.
Our experience demonstrates that the management of 5th metatarsal base fractures in the VFC setting, with a well-defined protocol, can prove safe, efficient, cost effective and yield good short term clinical outcomes.
骨折门诊的转诊量增加，接诊能力却下降。虚拟骨折门诊（VFC）是一种针对特定损伤表现的高效、安全且具有成本效益的解决方案。目前，尚无证据支持 VFC 模型在管理第 5 跖骨基底骨折中的应用。本研究旨在评估 VFC 管理第 5 跖骨基底骨折的临床结果和患者满意度。我们假设 VFC 模型安全且具有成本效益。
纳入 2019 年 1 月至 2019 年 12 月期间在我们的大型创伤中心 VFC 就诊的第 5 跖骨基底骨折患者。分析患者的人口统计学资料、就诊次数、并发症和手术率。患者接受标准化的 VFC 治疗； walker 靴/完全负重、康复信息，并告知如果症状在 4 个月后持续存在，需要联系 VFC。随访时间至少为 1 年；发放曼彻斯特-牛津足部问卷（MOXFQ）。进行了基本的成本分析。
符合纳入标准的患者共 126 例。平均年龄为 41.6 岁（18-92 岁）。从 ED 就诊到 VFC 复诊的平均时间为 2 天（1-5 天）。骨折根据劳伦斯和博特分类法进行分类，其中 104 例（82%）为 1 区骨折，15 例（12%）为 2 区骨折，7 例（6%）为 3 区骨折。在 VFC，126 例中有 125 例患者得到了出院处理。12 例（9.5%）在初次出院后进行了进一步的随访；所有病例的原因均为疼痛。研究期间发生 1 例骨折不愈合。1 年后的平均 MOXFQ 评分 0.4/64，只有 11 例患者的评分高于 0。总共节省了 248 次面对面就诊次数。
我们的经验表明，在 VFC 环境下，采用明确的方案治疗第 5 跖骨基底骨折，可以安全、高效、具有成本效益，且能获得良好的短期临床结果。
