The "COVID-19 Approach" to Distal Radius Fracture Management

[Treatment reality of distal radius fractures in a center]

Distal radius fractures are the third most common type of fracture in Germany after fractures of the femoral neck and peritrochanteric femoral fractures. In 2019 a total of 72,087 cases were registered with an incidence of 106 cases per 100,000 inhabitants (81,570 fractures of the femoral neck, 73,785 peritrochanteric fractures). Many of these fractures are surgically treated also in this hospital but with controversial views on the optimal treatment. Against the background of the coronavirus disease 2019 (COVID-19) pandemic, disappearing personnel resources and the political pressure to form centers and a switch to outpatient treatment, the authors ask the question what the treatment reality in this hospital looks like and whether the general changes in the framework conditions also have an affect in this context. This is not a strictly scientific study but a stocktaking without any claims of completeness and the retrospective evaluation of a larger data pool with all its weaknesses. On the contrary, the data provide interesting aspects that are explained in detail in the individual sections.

A national multicentre study of outcomes and patient satisfaction with the virtual fracture clinic and the influence of the COVID-19 pandemic: The MAVCOV study

BACKGROUND

Virtual fracture clinics (VFCs) are advocated by the British Orthopaedic Association Standards for Trauma (BOAST). We aimed to assess the impact of the transition from face-to-face fracture clinic review and identify any change in clinical outcome and patient satisfaction.

METHODS

A national, cross-sectional cohort study of VFCs across the UK over two separate two-week periods pre- and during the first UK COVID-19 lockdown was undertaken. Data comprising patient and injury characteristics, unplanned reattendance and complications within three months following discharge from VFC were collected by local collaborators. Telephone questionnaires were conducted to determine patient satisfaction and patient-reported outcome for patients discharged without face-to-face consultation. The primary outcome measure was the percentage of unplanned reattendances after direct discharge from VFC.

RESULTS

Data was analysed for 51 UK VFCs comprising 6134 patients from the pre-pandemic group (06/05/2019-19/05/2019) and 4366 patients from the first UK lockdown (04/05/2020-17/05/2020). During lockdown, the rate of direct discharge from VFC increased significantly (odds ratio (OR) 2.01, p<0.001) from 30 % (n = 1856/6134) to 46 % (n = 2021/4366). The rate of compliance with BOAST guidance recommending fracture clinic review within three days increased (OR 1.93, p<0.001) from 82 % (n = 5003/6134) to 89 % (n = 3883/4366). There were no differences in the rates of unplanned reattendance (6 % pre- and 7 % during lockdown, p = 0.281) or complications (0.2 % for both, p = 0.815). There were 1527/3877 patients discharged without face-to-face review from VFC who completed telephone questionnaires (mean follow-up 18-months in pre-pandemic group and 6-months in lockdown group). Satisfaction was high in both cohorts (80 % pre- and 76 % lockdown, p = 0.093). Dissatisfaction was associated with an unplanned reattendance (p<0.001) or a missed injury (p<0.05).

CONCLUSION

Despite a significant rise in direct discharge from VFC, there was no significant change in unplanned attendances, complications, or patient satisfaction. However, there are factors associated with dissatisfaction and these should be considered in the evolution of VFC.