The Virtual Fracture Clinic (VFC) was introduced at Medway in April 2018. It is collaboration between the Minor Injury Unit (MIU)/Emergency Department at Medway Maritime Hospital including the MIUs at Sittingbourne Memorial Hospital, Sheppey Community Hospital and Gravesham Community Hospital. Other healthcare providers can also refer into the VFC.
Many injuries do not require any specific input from a doctor or orthopaedic surgeon and can be self-managed by patients. The following conditions are directly discharged from ED/MIU with an advice leaflet for patients.
You have a sprain (partial disruption of ligament fibers) of the joint between the shoulder blade and collar bone.
This injury almost always heals well with time and use, no specific treatment is required and therefore routine follow-up is unnecessary.
A sling will hold your shoulder in a comfortable position for a few days. You should wean yourself off this as your pain settles and aim to remove the sling completely as soon as you feel able.
You may initially require regular painkillers as it is important to keep gently moving the shoulder and gradually resume daily activities within the limits of discomfort. This will prevent stiffness and ensure the quickest return to normal function.
Forcible stretching is unnecessary, and is likely to cause pain and delay your recovery.
Symptoms are usually minor, but may take 3-6 weeks to settle.
There may be slightly reduced movement at the shoulder, especially when lifting the arm, but this is likely to improve over time with normal use.
If the pain get worse or lasts more than six weeks or you are concerned about your shoulder, please contact the fracture clinic.
You have a very small break in the radial head or neck – one of the bones in your elbow.
These fractures almost always heal well with time and use, no specific treatment is required and therefore routine follow-up is unnecessary.
A collar and cuff will hold your elbow in a comfortable position for a few days. You should wean yourself off this as your pain settles and aim to remove the sling completely as soon as you feel able.
You may initially require regular painkillers as it is important to keep gently moving the elbow and gradually resume daily activities within the limits of discomfort. This will prevent stiffness and ensure the quickest return to normal function.
Forcible stretching is unnecessary, and is likely to cause pain and delay your recovery.
Symptoms are usually minor, but may take 3-6 weeks to settle.
There may be slightly reduced movement at the elbow, especially on straightening it, but this is unlikely to affect your function.
If the pain get worse or lasts more than eight weeks, or you are concerned about your elbow, please contact the fracture clinic.
You have been referred to Virtual Fracture Clinic (VFC).Your radiographs and injury details will be reviewed by an Upper Limb Orthopaedic Surgeon. You will be contacted by VFC with the outcome of advice. This is a specialised service please allow seven days for the referral to be processed.
What is injured?
The common cases of wrist pain following injury are:
- Ligament Sprain – this means stretch or tear of one of the wrist ligaments
- Bruising of the cartilage or bone
- Occult Fracture – Tiny crack of the bone which is not picked up early on radiographs.
These are all STABLE injuries. This means that the injury will generally heal in the exact same position as normal.
What are the Symptoms?
The main symptoms from these injuries are pain, Swelling and difficulty using the wrist. These symptoms can be severe to begin with but improve with time.
How long will it take to get better?
2 weeks after the injury the wrist may still be swollen but should feel comfortable
4 weeks – the swelling should have gone down, and the splint should no longer be required except for the periods of heavy activity.
6 weeks after the injury normal function should have returned.
What should I do with my wrist?
Aim to start moving the fingers as soon as possible after the injury. The splint can be removed after two weeks to begin gentle movements of the wrist. If pain and swelling are continuing to be a problem at this stage, leave the splint in place for a further week or two, and try again. If comfortable, you should remove the splint at night, but if the wrist remains sore or very swollen then keep the splint on.
Checklist
2 weeks – Comfortable in a splint, swelling may still be noticeable.
4 weeks – Able to do most activities in the splint. Non- manual workers should be back to work.
6 weeks –Free from splint with normal function.
If the pain get worse or lasts more than six weeks or you are concerned about your wrist, please contact the fracture clinic.
You have a minor break near the knuckle and it will usually settle in three weeks. It may take six weeks or longer before your hands returns to normal.
The finger strapping may help the pain and allow early movement.
Because the break can be close to the joint you must move your fingers and hand as soon as possible even if this means overcoming the discomfort.
After one week remove the strapping. Use your hand as normally as possible. This will not cause further damage but heavy lifting may be sore for 6 to 8 weeks.
Hand grip is generally very good after this type of injury. As the bone heals a lump will form at the break site and the knuckle will not be as prominent. There will be some shortening of the finger expected as a consequence of the injury.
If the pain get worse or lasts more than three weeks, or you are concerned about your hand, please contact the fracture clinic.
You have snapped the tendon that normally straightens the end joint of the finger.
The tendon may even pull off a small fragment of bone. This causes the tip of the finger to lie in a bent position and you are unable to straighten it.
A splint will be applied and should be worn continuously, even at night, to keep the finger straight for eight weeks (six weeks if there is a bony fragment).
During this time, it is important to keep the finger straight, even when taking the splint off to wash. This can be done by placing the hand flat on a table, removing the splint and cleaning the finger. Replace the splint without bending the finger.
At the end of this time the splint is worn for the next one month at night and whenever the finger might be at risk of injury.
Try to limit washing the finger as little as possible to reduce the chance of the finger bending. Initially aim for cleaning the finger twice a week. It is important to keep the finger and splint dry to avoid skin irritation.
Most injuries heal without any problems, however it may take several months to regain normal function.
After the splint has stopped being used (around 10 to 12 weeks) it is important to keep gently moving the finger and gradually resume daily activities within the limits of discomfort. This will help improve any stiffness and ensure the safest return to normal function.
There may be redness, swelling and slight pain over the joint for a few months, which will settle.
You may be left with a small bump or be unable to straighten the finger fully. This will be permanent but will not affect normal function.
Occasionally the tendon fails to heal and the finger ends up with a significant droop at the end joint. Surgical fusion of the end joint can then be considered.
If you are struggling to get movement back or you are concerned about your finger, please contact the fracture clinic.
Your child has fractured their clavicle (collar bone). This type of fracture is common in children.
Clavicle fractures heal well – the only treatments required are painkillers and a sling.
The fractured clavicle is likely to be painful for four to six weeks. Your child may find it more comfortable to sleep sitting upright for a few days after the injury.
The shoulder and arm can be moved out of the sling as pain allows. This will usually be about two weeks after the injury but can be sooner if comfortable.
As the fracture heals there will be a bump over the bone. This will disappear but can take one year to do so. If your child is older than ten years a small bump may remain.
Your child may return to sports such as swimming as soon as comfortable, but should avoid contact sports (such as football, rugby and basketball) for six weeks. If your child is still experiencing significant symptoms after 3 months, please contact the Fracture Clinic for further advice or follow-up.
If the pain get worse or lasts more than six weeks, or you are concerned about your child’s collar bone, please contact the fracture clinic.
Your child has suffered a “buckle” fracture of the arm/wrist. This is the most common type of fracture in young children.
Young bone is still soft and flexible. For this reason, instead of breaking all the way through, the bone has a small crack or kink on one side only. This fracture heals very well in a simple splint, which needs to be worn for three weeks.
In the early stages it is important to give your child appropriate doses of paracetamol or ibuprofen to help with the pain. After three weeks the splint can be removed, and simple day-to-day activities are encouraged.
In the first few weeks after splint removal the wrist is still likely to be a little sore and stiff. Strenuous and sports activities are only allowed when there is no pain and with normal wrist movements. If your child is reluctant to use the wrist please contact the Fracture Clinic for advice or Fracture Clinic follow-up.
If the pain get worse or lasts more than three weeks, or you are concerned about your child, please contact the fracture clinic.
You have sprained the ligaments in your ankle. This commonly causes pain and swelling, and in more severe cases visible bruising.
You may also experience weakness. In the early days after the injury RICE (rest, ice, elevation, compression) reduces the inflammation of the ankle.
You may be provided with a boot/shoe and use this as comfortable. You may wean off the orthotic as pain allows.
As soon as the acute pain and swelling settles, normal walking is allowed. It is advisable to wear flat shoes and to avoid walking on uneven ground.
More strenuous and sporting activities can be introduced gradually when the pain and swelling have settled down and normal walking is comfortable.
Minor sprains recover within a few weeks and don’t need specific treatment. More severe sprains may take longer to settle, and sometimes physiotherapy helps in recovering joint movements, muscle strength and stability.
It may take several months for the ankle to feel normal again and for the swelling to disappear completely.
Occasionally, the ankle sprain continues to be painful even after several months. In case there are on-going problems advice from an ankle specialist is advisable.
If there is no significant improvement in the pain or walking ability after four weeks, or if you are concerned about your ankle, please contact the fracture clinic.
You have broken a bone on the outer part of your foot.
The fracture has occurred in a part of the metatarsal bone which normally heals well without problems.
The pain, tenderness and swelling you are experiencing in the foot should gradually settle over a period of several weeks. During this time, you may find walking on the foot painful – it may help to walk on the heel initially.
You will be provided with a removable boot support for the foot. If required, you will also be provided with crutches.
You may walk on the foot as much as pain allows. The removable boot can usually be discarded gradually between three and five weeks after the injury as the pain settles. The usual healing time is six to eight weeks, but it may take several months for the foot to feel normal again.
Occasionally, the fracture may fail to heal (smoking is a risk factor) and continue to be painful even after several months. A surgical procedure may be needed at this stage to help heal the fracture.
If the pain gets worse or lasts more than eight weeks, or you are concerned about your foot, please contact the fracture clinic.
You have broken a bone in one of the small toes.
These fractures normally heal well without problems. The pain, tenderness and swelling you are experiencing in the toe should gradually settle over a period of several weeks.
During this time, you may find walking on the foot painful – it may help to walk on the heel initially.
Your broken toe will be strapped to the neighbouring toe. If required, you will also be provided with crutches.
It is best to wear good supportive shoes with plenty of room for your toes and firm soles. You may walk on the foot as much as pain allows.
The strapping can usually be discarded gradually after three weeks as the pain settles. The usual healing time is six weeks, but it may take several months for the foot to feel normal again.
Occasionally the fracture may fail to heal (smoking is a risk factor) and continue to be painful even after several months. A surgical procedure may be needed at this stage to help heal the fracture.
If the pain gets worse or lasts more than eight weeks, or you are concerned about your foot, please contact the fracture clinic.
Referrals
Patients requiring specialist orthopaedic review are referred for triage and Virtual Fracture Clinic review. In the VFC the clinical notes from the Emergency Department/ Minor Injury Unit and the radiographs are evaluated by an orthopaedic consultant. The consultant then decides on the best treatment for this particular patient; this might be advice given over the telephone regarding self-management of the injury, referral for physiotherapy or a face-to-face appointment in the fracture clinic. Generally patients get referred to the VFC by the following working day after presentation at MIU/ED, but sometimes there can be delays. We aim for all patients to be evaluated within 3 days. The patient then will be contacted by a nurse, who will explain about the decision. A letter is typed for the patient and the GP. Following this the patient will be either discharged, directed to a general or specialist fracture clinic with appointment, recalled for direct assessment if surgery is anticipated or referred for physiotherapy.
The virtual fracture clinic can be directly contacted by patients or their carers / guardians / parents if they have concerns. Please leave your name, hospital number and contact details on the answer phone.
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Your guide to conditions, symptoms and treatments
