Title : Virtual Fracture Clinics (VFCs) management of adult clavicle fractures: A retrospective observational study with implications for direct discharge protocols
Abstract:
Background: Clavicle fractures are common: up to 10% of adult fractures. Virtual Fracture Clinics (VFCs) are utilised across the UK to improve efficiency in trauma care, however, evidence guiding the safe direct discharge of adult clavicle fractures remains limited.
Aim: To determine the outcomes of adult patients with clavicle fractures reviewed in a VFC and whether specific patterns can be directly discharged without face-to-face review.
Methods: A retrospective review was conducted of all adult patients (≥16 years) referred to the VFC at a tertiary referral centre with a clavicle fracture between January 2022 and December 2023. Fractures were classified using the Robinson system. Discharge status, re-presentations, and subsequent requirement for surgical intervention were analysed.
Results: A total of 312 patients were included, aged 16–97 (median 51; IQR 42), of whom 65% were male. 170 (54%) were discharged directly and 26 (15.3%) re-presented, most commonly due to pain (n=11) or reinjury (n=5). Only 3 (1.8%) of these patients required surgical intervention. Overall, there were high surgical rates of 24.2% (24/99) in displaced midshaft and 13.2% (9/68) in displaced lateral compared to 0% (0/49) in undisplaced midshaft and 1.4% (1/74) in undisplaced lateral cases. Fracture displacement strongly predicted surgery (p<0.001): 18% (32/177) of displaced cases versus <2% (2/135) of undisplaced. Age was also significant (p=0.001): 2% of patients >60 undergoing surgery compared with 15–17% of younger patients.
Conclusion: Undisplaced midshaft and lateral clavicle fractures demonstrate negligible rates of operative intervention and may be suitable for direct discharge from VFC with appropriate safety-netting.
