{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T19:48:49Z","timestamp":1785786529218,"version":"3.56.0"},"reference-count":13,"publisher":"Royal College of Surgeons of England","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["annals"],"published-print":{"date-parts":[[2021,9]]},"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p> Early diagnosis is key to managing scaphoid fractures effectively. Computed tomography (CT) imaging can be effective if plain radiographs are negative. With increasing pressure on face-to-face clinics, consultant-led virtual fracture clinics (VFCs) are becoming increasingly popular. This study evaluates the management of patients with suspected scaphoid fractures using a standardised treatment protocol involving CT imaging and VFC evaluation. <\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p> The study was conducted at a busy district general hospital. The pathway began in February 2018. Patients presenting to the emergency department with a clinically suspected scaphoid fracture but an indeterminate radiograph had a CT scan, which was then reviewed in the VFC. Patients with a confirmed fracture were seen in a face-to-face clinic; patients without a confirmed fracture were discharged. Patient pathway outcome measures were analysed pre- and post-pathway, and a cost analysis was performed. <\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p> A total of 164 pre-pathway patients (93%) were given a face-to-face fracture clinic appointment; 76 were discharged after their first visit. Nine patients seen in clinic had a CT scan and were discharged with no fracture. If these patients had been referred to the VFC, had CT scans and been directly discharged, it would have saved \u00a31,629. A total of 41 patients from the post-pathway group (37%) had a CT scan and were discharged from the VFC. Avoiding face-to-face clinic appointments saved \u00a37,421. Extrapolating, the annual savings would be \u00a329,687. <\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p> This study shows that a VFC\/CT pathway to manage patients with a suspected scaphoid fracture is cost-effective. It limits face-to-face appointments by increasing use of CT to exclude fractures. <\/jats:p><\/jats:sec>","DOI":"10.1308\/rcsann.2021.0022","type":"journal-article","created":{"date-parts":[[2021,4,14]],"date-time":"2021-04-14T12:26:43Z","timestamp":1618403203000},"page":"678-682","source":"Crossref","is-referenced-by-count":5,"title":["Management of scaphoid fractures with CT scanning and virtual fracture clinic pathway reduces need for face-to-face clinic appointments"],"prefix":"10.1308","volume":"103","author":[{"given":"A","family":"Dutta","sequence":"first","affiliation":[{"name":"Maidstone and Tunbridge Wells NHS Trust, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G","family":"Crate","sequence":"additional","affiliation":[{"name":"St George\u2019s University Hospitals NHS Foundation Trust, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N","family":"Bakti","sequence":"additional","affiliation":[{"name":"East Kent Hospitals University NHS Foundation Trust, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J","family":"Nicholl","sequence":"additional","affiliation":[{"name":"Maidstone and Tunbridge Wells NHS Trust, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"171","reference":[{"key":"C1","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-319-31524-9"},{"key":"C2","doi-asserted-by":"publisher","DOI":"10.1080\/02844319950159145"},{"key":"C3","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhsa.2015.10.013"},{"key":"C4","doi-asserted-by":"publisher","DOI":"10.1016\/j.surge.2012.03.004"},{"key":"C5","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.81B1.0810091"},{"key":"C6","doi-asserted-by":"publisher","DOI":"10.1097\/00005373-199607000-00011"},{"key":"C7","doi-asserted-by":"publisher","DOI":"10.1308\/003588408X300948"},{"key":"C8","doi-asserted-by":"publisher","DOI":"10.1136\/emermed-2011-200676"},{"key":"C9","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.I.01523"},{"key":"C10","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2014-005282"},{"key":"C11","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.2016150995"},{"key":"C12","doi-asserted-by":"publisher","DOI":"10.1016\/j.jse.2013.11.006"},{"key":"C13","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2017.01.041"}],"container-title":["The Annals of The Royal College of Surgeons of England"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publishing.rcseng.ac.uk\/doi\/pdf\/10.1308\/rcsann.2021.0022","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,5,15]],"date-time":"2023-05-15T10:38:12Z","timestamp":1684147092000},"score":1,"resource":{"primary":{"URL":"https:\/\/publishing.rcseng.ac.uk\/doi\/10.1308\/rcsann.2021.0022"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9]]},"references-count":13,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2021,9]]}},"alternative-id":["10.1308\/rcsann.2021.0022"],"URL":"https:\/\/doi.org\/10.1308\/rcsann.2021.0022","relation":{},"ISSN":["0035-8843","1478-7083"],"issn-type":[{"value":"0035-8843","type":"print"},{"value":"1478-7083","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9]]}}}