Which fractures are suitable for virtual follow-up?

Fractures Suitable for Virtual Follow-up

Stable, non-displaced fractures of the lesser toes and fifth metatarsal base fractures are most suitable for virtual follow-up, as these can be safely managed with conservative treatment and have excellent outcomes with remote monitoring.

Suitable Fracture Types for Virtual Follow-up

Toe Fractures

• Stable, non-displaced fractures of the lesser toes (2nd-5th digits)
• Fractures of the proximal phalanx base of the 5th digit
• Toe fractures treated conservatively with buddy taping and rigid-sole shoes

Fifth Metatarsal Base Fractures

• Non-displaced fifth metatarsal base fractures
• Avulsion fractures at the base of the fifth metatarsal

Evidence Supporting Virtual Management

Virtual fracture clinics (VFCs) have demonstrated high effectiveness for conservatively managed fractures:

• 92.9% patient satisfaction rate for toe fractures managed virtually 1
• 98.2% of patients found virtual advice helpful for toe fracture management 1
• Median recovery time of 6 weeks for toe fractures managed through VFCs 1
• Base fractures of the fifth proximal phalanx treated with buddy taping and immediate mobilization showed high overall satisfaction with minimal complications 2

Required Initial Assessment Before Virtual Follow-up

1. Three-view radiographs (anteroposterior, lateral, and oblique) to confirm:

   • Fracture type and location
   • Absence of displacement or minimal displacement
   • No intra-articular involvement exceeding 25% of joint surface 3, 4

2. Initial in-person assessment to:

   • Confirm adequate circulation
   • Rule out open fractures or significant soft tissue injury
   • Ensure proper initial management (buddy taping, appropriate footwear)
   • Provide patient education on self-care

Exclusion Criteria for Virtual Follow-up

Fractures requiring in-person follow-up include:

• Displaced intra-articular fractures
• Fractures with circulatory compromise
• Open fractures
• Fractures with significant soft tissue injury
• Fracture-dislocations
• First toe (hallux) fractures that are unstable or involve >25% of joint surface 4
• Displaced Salter-Harris fractures in children 4
• Jones fractures in high-demand athletes (at risk for nonunion) 3

Virtual Follow-up Protocol

1. Initial virtual review within 72 hours of emergency department visit 5
2. Patient education on:
   • Expected recovery timeline (typically 6 weeks for toe fractures)
   • Proper buddy taping technique
   • Weight-bearing status
   • Red flags requiring immediate in-person assessment
3. Follow-up virtual consultation at 2-3 weeks to:
   • Assess pain levels
   • Review self-reported healing
   • Address any concerns
   • Determine if in-person assessment is needed

Benefits of Virtual Follow-up

• Cost reductions ranging from $53-$297 per patient compared to traditional fracture clinics 6
• Reduced waiting times (mean 1.3 days vs 10.7 days with traditional clinics) 5
• High patient satisfaction rates (>92%) 1
• Compliance with British Orthopaedic Association guidelines for timely review 5

Pitfalls and Caveats

• Initial assessment must rule out fractures requiring surgical intervention
• Clear protocols must be established for escalation to in-person care if needed
• Patient selection is critical - only stable fractures with low risk of complications should be managed virtually
• Ensure patients understand warning signs requiring immediate in-person assessment
• Virtual follow-up may be less suitable for elderly patients or those with cognitive impairments who may have difficulty with self-assessment

By implementing a structured virtual follow-up program for appropriate fractures, healthcare providers can improve efficiency while maintaining high-quality care and patient satisfaction.