The unrestrained ordering of advanced 3D imaging on all pediatric patients with potential scaphoid injuries is impracticable and expensive. Unnecessary clinic visits can be time-consuming for clinicians and parents (who often have to take time off work) and upsetting for young children. Traditional outpatient fracture clinic models review the patient a week or more post-injury with clinical assessment and repeat designated scaphoid radiographs . Although rare, missed scaphoid fractures may lead to non-union, avascular necrosis, and significant morbidity previous work suggests that injury characteristics in children mirror that seen in adults . Scaphoid fractures can be challenging to diagnose at initial presentation due to the lack of acute radiological signs in 30% of cases . They account for 0.34% of all pediatric fractures, 0.45% of all pediatric upper limb fractures, and 3% of all pediatric hand and wrist fractures . Scaphoid fractures are the most common carpal bone fracture in the pediatric population, with an average annual incidence of 11 per 100,000 . This cohort presents no 'missed' injuries and therefore appears safe compared to conventional treatment pathways.

Twenty-six patients required further review in a face-to-face clinic after their second radiograph.Ĭonclusion: VFC appears to be a safe and efficient method of managing patients with suspected scaphoid fractures on short-term follow-up analysis. Following the second radiograph, 78 patients were discharged directly. The pathway managed all patients as intended 71 patients were seen face-to-face in the clinic due to age or pathology picked up on the first x-ray, and 104 required repeat radiographs. Results: The pathway received 175 referrals 114 male, 61 female, mean age 14 years, range 9-17) with 42 scaphoid fractures diagnosed, 35 (83.3%) on first x-ray, and 7 (16.7%) occult fractures. Patients with unremarkable second x-rays were contacted and informed to mobilize and return if the pain persisted at four weeks. Based on their notes and imaging, patients were referred to an outpatient clinic for repeat radiographs within two weeks (if initial radiographs demonstrated no fracture). Patients received an 'appointment' in VFC. Method: Data was reviewed for patients referred via the VFC for suspected scaphoid fractures at a local trauma unit over 19 months.

Introduction: The mismanagement of an occult scaphoid fracture is a significant concern in patients presenting with anatomical snuffbox tenderness and no radiographic signs of injury.Īim: This study investigated whether a virtual fracture clinic (VFC) could improve care efficiency and expedite management decisions surrounding suspected pediatric scaphoid fractures.

Streamline by Jennifer Lane