Ahmed Mohammed, Adithya Venkatasubramanian
The VFC pathway was associated with significantly reduced BOAST-compliant surgical timing. This association may in part reflect an additional clinic step prior to listing, although causation cannot be established from this retrospective design; the findings should be regarded as hypothesis-generating. Departments using VFC pathways should consider a direct-listing escalation protocol for fractures meeting operative criteria, to avoid breaching hyper-acute BOAST windows.
BACKGROUND: Distal radius fractures are common trauma presentations. The British Orthopaedic Association Standards for Trauma (BOAST) guidelines mandate surgical fixation within 72 hours for unstable intra-articular fractures and within seven days for extra-articular fractures. Virtual fracture clinics (VFCs) are now the dominant National Health Service (NHS) triage model, but their effect on time-critical surgical decision-making is unclear. This service evaluation assessed whether the VFC pathway delays operative management of distal radius fractures relative to BOAST standards, compared with traditional trauma-meeting triage.
METHODS: We conducted a retrospective service evaluation of adult patients undergoing open reduction and internal fixation (ORIF) of a distal radius fracture over seven months at Lincoln County Hospital, United Lincolnshire Teaching Hospitals NHS Trust, Lincoln, England, United Kingdom. Patients were stratified by triage route (VFC vs. traditional trauma meeting) and fracture morphology. BOAST compliance was compared between pathways using Fisher's exact test, with odds ratios (ORs) and 95% confidence intervals (CIs).
RESULTS: Of 25 ORIF cases, 92% (23/25) were intra-articular. Overall BOAST compliance was 12% (3/25). Compliance was 0% (0/17) in the VFC cohort versus 37.5% (3/8) in the traditional trauma-meeting cohort (Fisher's exact p = 0.0243; OR 0.045, 95% CI 0.002-0.93).
CONCLUSION: The VFC pathway was associated with significantly reduced BOAST-compliant surgical timing. This association may in part reflect an additional clinic step prior to listing, although causation cannot be established from this retrospective design; the findings should be regarded as hypothesis-generating. Departments using VFC pathways should consider a direct-listing escalation protocol for fractures meeting operative criteria, to avoid breaching hyper-acute BOAST windows.