{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T16:05:35Z","timestamp":1773245135201,"version":"3.50.1"},"reference-count":38,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,10,27]],"date-time":"2023-10-27T00:00:00Z","timestamp":1698364800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Digit. Health"],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Virtual fracture clinics (VFC) involve a consultant-led multidisciplinary team meeting where cases are reviewed before a telephone consultation with the patient. VFCs have the advantages of reducing waiting times, outpatient appointments and time off school compared to face-to-face (F2F) fracture clinics. There has been a surge in VFC use since the COVID-19 pandemic but there are still concerns over safety in the paediatric population. Fractures make up a large burden of paediatric injuries, therefore research is required on the safety and efficacy of paediatric VFCs. This systematic review will look at the safety and effectiveness of paediatric VFCs, as well as determine the cost-effectiveness and parent preferences.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>As per the PRISMA guidelines two independent reviewers searched the following databases: Medline, Embase and Web of Science. Studies were included if children under 18 years old presented to A&amp;amp;E with a suspected or confirmed simple un-displaced fracture and were referred to a VFC. The primary outcomes assessed were effectiveness and safety, with the secondary outcomes of cost-effectiveness and parent satisfaction.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Six studies met the inclusion criteria for this systematic review. There was a high rate of direct discharge from the VFC leading to reduced outpatient appointments. All patients were seen within 72\u2005h of presentation. There were limited incidences of missed fractures and the rates of re-presentation were similar to that of F2F orthopaedic clinics. There were significant cost savings for the hospitals and high parent satisfaction.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>VFCs have shown to be safe and effective at managing most stable, low operative risk paediatric fractures. Safety must be ensured with a telephone helpline and an open return to fracture clinic policy. More research is needed into specific paediatric fracture types to be managed in the VFC.<\/jats:p><\/jats:sec><jats:sec><jats:title>Systematic Review Registration<\/jats:title><jats:p><jats:ext-link>https:\/\/www.crd.york.ac.uk\/PROSPERO\/#searchadvanced<\/jats:ext-link>, identifier: CRD42023423795.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fdgth.2023.1261035","type":"journal-article","created":{"date-parts":[[2023,10,28]],"date-time":"2023-10-28T21:24:01Z","timestamp":1698528241000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["How safe and effective are paediatric virtual fracture clinics? A systematic review"],"prefix":"10.3389","volume":"5","author":[{"given":"Emma","family":"Waite","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zubair","family":"Ahmed","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2023,10,27]]},"reference":[{"key":"B1","first-page":"22","article-title":"The Glasgow fracture pathway: a virtual clinic","volume":"2","author":"Jenkins","year":"2014","journal-title":"BJJ News"},{"key":"B2","doi-asserted-by":"publisher","first-page":"293","DOI":"10.1302\/2633-1462.16.BJO-2020-0041.R1","article-title":"Design and implementation of an acute trauma and orthopaedic ePlatform (TOP) referral system utilising existing secure technology during the COVID-19 pandemic","volume":"1","author":"McIntyre","year":"2020","journal-title":"Bone Jt Open"},{"key":"B3","doi-asserted-by":"publisher","first-page":"e005282","DOI":"10.1136\/bmjopen-2014-005282","article-title":"Effect of a redesigned fracture management pathway and \u201cvirtual\u201d fracture clinic on ED performance","volume":"4","author":"Vardy","year":"2014","journal-title":"BMJ Open"},{"key":"B4","year":"2014"},{"key":"B5","doi-asserted-by":"publisher","first-page":"913","DOI":"10.1016\/j.injury.2007.01.036","article-title":"The epidemiology of fractures in children","volume":"38","author":"Rennie","year":"2007","journal-title":"Injury"},{"key":"B6","doi-asserted-by":"publisher","first-page":"1410","DOI":"10.1016\/j.injury.2016.04.007","article-title":"The economic burden of outpatient appointments following paediatric fractures","volume":"47","author":"Holm","year":"2016","journal-title":"Injury"},{"key":"B7","doi-asserted-by":"publisher","first-page":"395","DOI":"10.1016\/j.injury.2005.12.010","article-title":"The socio-economical impact of paediatric fracture clinic appointments","volume":"37","author":"Morris","year":"2006","journal-title":"Injury"},{"key":"B8","doi-asserted-by":"publisher","first-page":"152","DOI":"10.1097\/PEC.0b013e3181ce310c","article-title":"Common pediatric fractures treated with minimal intervention","volume":"26","author":"Boutis","year":"2010","journal-title":"Pediatr Emerg Care"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1664","DOI":"10.1016\/j.injury.2015.05.041","article-title":"Fifth metatarsal fractures\u2014is routine follow-up necessary?","volume":"46","author":"Ferguson","year":"2015","journal-title":"Injury"},{"key":"B10","doi-asserted-by":"publisher","first-page":"1507","DOI":"10.1503\/cmaj.100119","article-title":"Cast versus splint in children with minimally angulated fractures of the distal radius: a randomized controlled trial","volume":"182","author":"Boutis","year":"2010","journal-title":"CMAJ"},{"key":"B11","doi-asserted-by":"publisher","first-page":"1150","DOI":"10.1097\/PEC.0b013e3182716fea","article-title":"Gartland type I supracondylar humerus fractures in children: is splint immobilisation enough?","volume":"28","author":"Cuomo","year":"2012","journal-title":"Pediatr Emerg Care"},{"key":"B12","doi-asserted-by":"publisher","first-page":"495","DOI":"10.1097\/01.bpo.0000161098.38716.9b","article-title":"Minimalistic approach to treating wrist torus fractures","volume":"25","author":"van Bosse","year":"2005","journal-title":"J Pediatr Orthop"},{"key":"B13","doi-asserted-by":"publisher","first-page":"331","DOI":"10.1308\/003588402760452457","article-title":"Management of paediatric clavicle fractures\u2014is follow-up necessary? An audit of 346 cases","volume":"84","author":"Calder","year":"2002","journal-title":"Ann R Coll Surg Engl"},{"key":"B14","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1097\/PEC.0b013e318163db13","article-title":"A randomized controlled trial of 2 methods of immobilizing torus fractures of the distal forearm","volume":"24","author":"Oakley","year":"2008","journal-title":"Pediatr Emerg Care"},{"key":"B15","doi-asserted-by":"publisher","first-page":"508","DOI":"10.1016\/j.injury.2012.11.018","article-title":"Soft cast versus rigid cast for treatment of distal radius buckle fractures in children","volume":"44","author":"Witney-Lagen","year":"2013","journal-title":"Injury"},{"key":"B16","doi-asserted-by":"publisher","first-page":"555","DOI":"10.1097\/PEC.0b013e31828e56fb","article-title":"A randomized controlled trial of cast versus splint for distal radial buckle fracture","volume":"29","author":"Williams","year":"2013","journal-title":"Pediatr Emerg Care"},{"key":"B17","year":"2013"},{"key":"B18","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1308\/rcsann.2016.0255","article-title":"Virtual fracture clinic delivers British orthopaedic association compliance","volume":"99","author":"Holgate","year":"2017","journal-title":"Ann R Coll Surg Engl"},{"key":"B19","year":"2015"},{"key":"B20","year":"2016"},{"key":"B21","doi-asserted-by":"publisher","first-page":"2757","DOI":"10.1016\/j.injury.2020.11.001","article-title":"Virtual fracture clinics in orthopaedic surgery\u2014a systematic review of current evidence","volume":"51","author":"Davey","year":"2020","journal-title":"Injury"},{"key":"B22","doi-asserted-by":"publisher","first-page":"683","DOI":"10.1302\/2633-1462.111.BJO-2020-0107.R1","article-title":"How useful are virtual fracture clinics?: a systematic review","volume":"1","author":"Khan","year":"2020","journal-title":"Bone Jt Open"},{"key":"B23","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"Br Med J"},{"key":"B24","author":"Higgins","year":"2022"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1177\/1357633X221076695","article-title":"Trauma assessment clinic: a virtual fracture clinic model that delivers on its PROMise!","author":"O\u2019Reilly","year":"2022","journal-title":"J Telemed Telecare"},{"key":"B26","doi-asserted-by":"publisher","first-page":"2101","DOI":"10.1016\/j.injury.2017.08.006","article-title":"Paediatric fracture clinic re-design: incorporating a virtual fracture clinic","volume":"48","author":"Robinson","year":"2017","journal-title":"Injury"},{"key":"B27","doi-asserted-by":"publisher","first-page":"186","DOI":"10.1302\/1863-2548.15.200235","article-title":"One and done? Outcomes from 3961 patients managed via a virtual fracture clinic pathway for paediatric fractures","volume":"15","author":"Kennedy","year":"2021","journal-title":"J Child Orthop"},{"key":"B28","doi-asserted-by":"publisher","first-page":"e29238","DOI":"10.7759\/cureus.29238","article-title":"A virtual fracture clinic pathway for managing suspected paediatric scaphoid fractures","volume":"14","author":"Aboelmagd","year":"2022","journal-title":"Cureus"},{"key":"B29","doi-asserted-by":"publisher","first-page":"e202","DOI":"10.1097\/pq9.0000000000000202","article-title":"Introducing a virtual fracture clinic increases efficiency and reduces costs in torus fracture management","volume":"4","author":"Seewoonarain","year":"2019","journal-title":"Pediatr Qual Saf"},{"key":"B30","first-page":"25","article-title":"Virtual fracture clinic-two year follow up of paediatric patients directly discharged from emergency department with orthopaedic injuries","volume":"86","author":"Breathnach","year":"2020","journal-title":"Acta Orthop Belg"},{"key":"B31","doi-asserted-by":"publisher","first-page":"847","DOI":"10.1302\/0301-620X.93B6.26670","article-title":"Avascular necrosis of the scaphoid in children treated by splint immobilisation","volume":"93","author":"Gunal","year":"2011","journal-title":"J Bone Joint Surg Br"},{"key":"B32","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1097\/PEC.0000000000000473","article-title":"An evaluation of the accuracy and necessity of fracture clinic referrals in a busy pediatric emergency department","volume":"32","author":"Ramasubbu","year":"2016","journal-title":"Pediatr Emerg Care"},{"key":"B33","doi-asserted-by":"publisher","first-page":"96","DOI":"10.1186\/1756-0500-7-96","article-title":"Paediatric fracture clinic design\u2014current practice and implications for change","volume":"7","author":"Huntley","year":"2014","journal-title":"BMC Res Notes"},{"key":"B34","doi-asserted-by":"publisher","first-page":"838","DOI":"10.1007\/s11999-015-4602-5","article-title":"What are the 30-day readmission rates across orthopaedic subspecialties?","volume":"474","author":"Bernatz","year":"2016","journal-title":"Clin Orthop Relat Res"},{"key":"B35","doi-asserted-by":"publisher","first-page":"765","DOI":"10.1016\/j.jpedsurg.2017.08.003","article-title":"US Pediatric trauma patient unplanned 30-day readmissions","volume":"53","author":"Wheeler","year":"2018","journal-title":"J Pediatr Surg"},{"key":"B36","doi-asserted-by":"publisher","first-page":"a1518","DOI":"10.1136\/bmj.a1518","article-title":"Patterns of skeletal fractures in child abuse: systematic review","volume":"337","author":"Kemp","year":"2008","journal-title":"Br Med J"},{"key":"B37","doi-asserted-by":"publisher","first-page":"172571","DOI":"10.1155\/2011\/172571","article-title":"Conservative management of paediatric clavicle fractures","volume":"2011","author":"O\u2019Neill","year":"2011","journal-title":"Int J Pediatr"},{"key":"B38","doi-asserted-by":"publisher","first-page":"376","DOI":"10.1016\/j.injury.2010.09.036","article-title":"Outcome of distal clavicular fracture separations and dislocations in immature skeleton","volume":"42","author":"Nenopoulos","year":"2011","journal-title":"Injury"}],"container-title":["Frontiers in Digital Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fdgth.2023.1261035\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,28]],"date-time":"2023-10-28T21:24:06Z","timestamp":1698528246000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fdgth.2023.1261035\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10,27]]},"references-count":38,"alternative-id":["10.3389\/fdgth.2023.1261035"],"URL":"https:\/\/doi.org\/10.3389\/fdgth.2023.1261035","relation":{},"ISSN":["2673-253X"],"issn-type":[{"value":"2673-253X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,10,27]]},"article-number":"1261035"}}