title: Virtual fracture clinic management of fifth metatarsal, including Jones', fractures is safe and cost-effective.
abstract: 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.
authors.affiliation: Royal Sussex County Hospital, Brighton, East Sussex, BN25BE, United Kingdom. Electronic address: kitbrogan@mac.com.
authors.forename: Kit
authors.initials: K
authors.lastname: Brogan
authors.affiliation: Royal Sussex County Hospital, Brighton, East Sussex, BN25BE, United Kingdom.
authors.forename: Simon
authors.initials: S
authors.lastname: Bellringer
authors.affiliation: Royal Sussex County Hospital, Brighton, East Sussex, BN25BE, United Kingdom.
authors.forename: Harold
authors.initials: H
authors.lastname: Akehurst
authors.affiliation: Royal Sussex County Hospital, Brighton, East Sussex, BN25BE, United Kingdom.
authors.forename: Christopher
authors.initials: C
authors.lastname: Gee
authors.affiliation: Royal Sussex County Hospital, Brighton, East Sussex, BN25BE, United Kingdom.
authors.forename: Nada
authors.initials: N
authors.lastname: Ibrahim
authors.affiliation: Royal Sussex County Hospital, Brighton, East Sussex, BN25BE, United Kingdom.
authors.forename: Lucy
authors.initials: L
authors.lastname: Cassidy
authors.affiliation: Royal Sussex County Hospital, Brighton, East Sussex, BN25BE, United Kingdom.
authors.forename: Ben
authors.initials: B
authors.lastname: Rogers
authors.affiliation: Royal Sussex County Hospital, Brighton, East Sussex, BN25BE, United Kingdom.
authors.forename: James
authors.initials: J
authors.lastname: Gibbs
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000592:standards*; D002648:Child; D002985:Clinical Protocols; D003362:Cost-Benefit Analysis; D019091:Critical Pathways / Q000458:organization & administration; D004638:Emergency Treatment / Q000191:economics; D005260:Female; D050723:Fractures, Bone / Q000628:therapy*; D006801:Humans; D008297:Male; D008682:Metatarsal Bones / Q000293:injuries*; D008875:Middle Aged; D017216:Telemedicine / Q000191:economics; D006113:United Kingdom / Q000453:epidemiology; D019564:Unnecessary Procedures; D014584:User-Computer Interface; D016474:Weight-Bearing; D055815:Young Adult
keywords: Fifth metatarsal fractures; Jones’ fractures; VFC; Virtual fracture clinic