title: Do Broken Toes Need Follow-Up in the Fracture Clinic?
abstract: Most toe phalangeal fractures can be successfully treated nonoperatively without any residual deformity and are usually clinically asymptomatic. Toe phalangeal fractures are nevertheless common fracture clinic referrals. Our aim was to evaluate the injury characteristics of patients with toe fractures attending a fracture clinic and to understand how current management affects the fracture clinic workload. We retrospectively evaluated all new referrals to a subspecialized foot and ankle fracture clinic during a 12-month period at our institution under the care of 1 consultant. Data were collected regarding patient demographics, fracture type, patient outcome, and the number of clinic appointments attended, cancelled, or not attended. A total of 707 new patients (mean age 39 ± 19 years; 345 males, 362 females) were seen in 47 foot and ankle fracture clinics within the study period. Seventy-four phalangeal fractures were identified in 65 patients. A total of 135 outpatient appointments were scheduled for these patients (initial and follow-up), with 93 (69%) attended, 25 (19%) not attended, and 15 (11%) cancelled and rescheduled at the patient's request. Seventeen patients (13%) failed to attend their first clinic appointment. The results of the present study highlight that 9% of all new patient referrals to a fracture clinic were for toe phalangeal fractures. Only 2 patients required surgery for significant loss of articular congruency or deformity. No patient subsequently developed a symptomatic malunion or required toe surgery during the following 2 years. We believe that undisplaced and stable toe phalangeal fractures do not need to be referred to the fracture clinic. This would result in a reduction of outpatient appointments for toe fractures by 52%.
authors.affiliation: Registrar, Trauma and Orthopaedics, University College London Hospitals National Health Service Foundation Trust, London, United Kingdom.
authors.forename: Timothy B
authors.initials: TB
authors.lastname: Eves
authors.affiliation: Consultant Surgeon, Trauma and Orthopaedics, University College London Hospitals National Health Service Foundation Trust, London, United Kingdom. Electronic address: mike.oddy@uclh.nhs.uk.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Oddy
mesh_terms: D000293:Adolescent; D000328:Adult; D000359:Aftercare; D002648:Child; D004636:Emergency Service, Hospital; D005260:Female; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D008297:Male; D011859:Radiography; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D050277:Toe Phalanges / Q000000981:diagnostic imaging / Q000293:injuries*
keywords: appointment; fracture; phalanx; toe