Abstract
BACKGROUND: Virtual fracture clinics (VFCs) have been proposed as an efficacious alternative to face-to-face (FTF) fracture clinics. Better usage of clinical time and resources, increased accessibility, decreased patient wait times and reduced cost may be advantages of the VFC. This study aims to assess the clinical efficacy and patient satisfaction of the VFC in the UK since introduced in 2011 and determine whether VFCs should become the leading pathway for acute traumatic orthopaedic (ATO) care. METHODS: A systematic review of studies from 2011 up to April 2025 was conducted, identifying all relevant literature to the safety and efficacy of VFCs. MEDLINE, PubMed and the Cochrane library were searched according to our search strategy. Systematic screening and application of our inclusion and exclusion criteria resulted in twenty-five included studies. These studies included: retrospective cohort studies, case series and interrupted time series, prospective and cross-sectional cohort studies, closed loop audits and service evaluations. Key clinical efficacy outcomes assessed included: VFC discharge rates, adherence to BOAST 72-h guidelines, missed injuries, inappropriate referrals/radiographs, reattendances, and the number of FTF fracture clinic follow ups following VFC review. Additional outcomes assessed were patient reported outcome measures and patient satisfaction data. RESULTS: A cohort of 63,367 patients contributed to the clinical efficacy summative outcomes. VFCs reported an 83.6% mean compliance rate with British Orthopaedic Association Standards for Trauma 72-h guidelines, compared to 5.7% for FTF fracture clinics. VFCs make minimal diagnostic errors and as a result reported a low mean reattendance rate following discharge of 4.9%. Patients have good health outcomes, a high mean satisfaction rate of 85.4% for VFCs and prefer them to FTF fracture clinics. CONCLUSION: This systematic review demonstrates that VFCs are highly efficacious in managing ATO patients in the UK and that patients are satisfied with their care. VFCs outperform FTF fracture clinics and could become the standard pathway for management of ATO injuries across the UK in the future. In the meantime, further research is needed to validate these comparisons between VFCs and FTF fracture clinics to definitively conclude that VFCs should become the leading pathway.