Mr Piers Truter1,2, Mr Tristan Wuu4, Dr Sandeep B1,3
1Fiona Stanley Hospital, Murdoch, Australia, 2University of Notre Dame Australia, Fremantle, Australia, 3Fremantle Hospital, Hand Surgery Service, Fremantle, Australia, 4Curtin University of Technology, Bentley, Australia
Intro: Closed fractures of the fifth metacarpal neck are stable, do not improve with reduction and immobilisation and rarely have any significant complications. They are routinely managed with buddy taping and patient education in many overseas health services. We identified potential overtreatment of these fractures and that patients may return to work earlier, with better functional outcomes, when not managed in plaster. We launched a new physiotherapist lead TeleHealth fracture service (TFS) for patients with boxer’s fractures in November 2020.
Methods: This is retrospective hand surgery service audit, with prospective data collection for the new TFS. We audited 115 cases of closed fifth metacarpal fracture managed in plaster and treated by in-person attendance to the hand surgery clinic in 2019-2020. After a review of the initial audit by a multi-disciplinary working group, we changed our default management to buddy taping and TeleHealth fracture care. We conducted a descriptive statistical comparison of the two service models.
Results: There were 115 cases in our retrospective audit and 100 cases from our TFS prospective data collection. Patients had 2.3 fewer appointments and 3.2 fewer x-rays when seen in the TFS. The TFS treated 98% of patients by telehealth. The DNA rate dropped from 16% to 10%. Patients returned to work at day 7. The average PRWHE scores for TFS patients at their first clinic contact was 44. We estimate a cost saving of $500 per patient.
Conclusions: Preliminary analysis of TeleHealth management of buddy taped boxer’s fractures supports this cost-effective model of care.
Piers is a clinical academic who splits his time between co-ordinating the post-graduate program in the School of Physiotherapy and working in two advanced scope of practice roles at Fiona Stanley Hospital. He completed his original physiotherapy degree in Brisbane and after working in rural and remote Queensland, moved to Perth to complete his master’s degree in Clinical Physiotherapy at Curtin University. He is currently completing his PhD, investigating the contemporary conservative management of fractures. His research interests include; TeleHealth, Fracture Care, Emergency Department musculoskeletal care and Health Service Improvement.
As a physiotherapist, Piers has experience working in Private Practice, various hospital in-patient settings, Indigenous clinical settings, TeleHealth, Emergency Department, Aged Care and with Sports Teams. He has worked as an Advanced Scope Physiotherapist in the Emergency Department setting since 2014, at Fiona Stanley Hospital, SJOG Midland (Clinical Lead) and Gold Coast University Hospital. In 2020 he developed and launched a physiotherapy lead ‘Virtual Fracture Clinic’ (orthopaedic fracture care TeleHealth) at Fiona Stanley.