Protocol deviations in distal radius fracture follow-up in a virtual fracture care model

This study aims to evaluate protocol adherence in the follow-up of patients with distal radius fractures (DRFs) managed within the Virtual Fracture Care (VFC) model, and to explore predictors and patterns of deviation across VFC pathways.

We conducted a retrospective cohort study at a Dutch level 2 trauma center, including 1,677 adult patients with DRFs managed within VFC from January 2022 to January 2024. Actual follow-up was compared with the follow-up planned during the VFC multidisciplinary team meetings. Deviation from the plan was classified as either more or less follow-up than planned. Multivariable regression was used to identify predictors of deviation, and ED reattendance rates were analyzed for clinical outcomes.

A total of 80.2% of patients deviated from their VFC plan. Non-operative patients (with and without closed reduction) most frequently received less follow-up than planned, while operatively treated patients often received more follow-up. ED reattendance rates were low (2.1%-6.6%), with patients receiving less follow-up having the lowest rates (3.1%).

High non-adherence rates were observed, but most deviations reflected optimal recovery with minimal follow-up, rather than inefficiency. The VFC model provides efficient and safe follow-up care, but there is potential for further optimization through facultative symptom-based follow-up strategies.