Abstract
Close contact casting (CCC) is a non-surgical treatment for certain types of fractures, using tight moulding to achieve anatomical alignment. During the COVID-19 pandemic, when healthcare systems globally were under severe strain, conservative management such as CCC was a more widely used alternative to surgical management. However, it has since been considered that a large cohort of patients over 60 may have similar functional outcomes, fewer complications, and lower associated costs when comparing CCC to surgical management. Currently, there is no validated tool to determine which patients could be more suitable for CCC. This technical report proposes the surgical risk vs benefit assessment of fracture management in the elderly (SAFME) scoring tool. The SAFME scoring tool uses thirteen parameters of patient demographics to objectively evaluate conservative management against surgery, and guide clinicians' decision-making for treatment. Furthermore, a fracture clinic protocol (FCP) being incorporated into practice would allow for the careful multidisciplinary monitoring of elderly patients with fractures who have followed the CCC pathway, ensuring safe and effective care. The SAFME scoring tool would require testing through retrospective analysis and prospective trials to refine scoring thresholds, evaluate safety, and assess its cost-effectiveness before implementation. If validated, the scoring tool could be used to support more individualised, evidence-based, and resource-efficient fracture management in elderly adults.