A Virtual Fracture Clinic Pathway for Managing Suspected Paediatric Scaphoid Fractures

Area of Science:

• Orthopedic surgery
• Pediatric trauma care
• Digital health innovations

Background:

• Occult scaphoid fractures are a diagnostic challenge, especially in pediatric patients with anatomical snuffbox tenderness but no initial radiographic evidence.
• Mismanagement can lead to significant patient concern and delayed treatment.

Purpose of the Study:

• To evaluate the efficiency and safety of a virtual fracture clinic (VFC) for managing suspected pediatric scaphoid fractures.
• To determine if VFC can expedite diagnostic and treatment decisions.

Main Methods:

• A retrospective review of patients referred to a VFC for suspected scaphoid fractures over 19 months.
• Patients received VFC appointments, with initial imaging reviewed and follow-up repeat radiographs scheduled within two weeks if necessary.
• Patients with negative second radiographs were advised on mobilization and follow-up if symptoms persisted.

Main Results:

• The VFC pathway managed 175 referrals (42 scaphoid fractures diagnosed, including 7 occult fractures).
• 71 patients required face-to-face consultation, and 104 had repeat radiographs.
• Direct discharge occurred for 78 patients post-second radiograph, with 26 needing further face-to-face review.

Conclusions:

• The virtual fracture clinic (VFC) model demonstrates safety and efficiency in managing suspected pediatric scaphoid fractures.
• No missed injuries were identified in this cohort, suggesting VFC is a safe alternative to conventional pathways.
• VFC facilitates timely decision-making and appropriate patient disposition for pediatric wrist injuries.