Telehealth seen as safe, satisfactory tool for treatment of non-displaced pediatric elbow fractures

NEW ORLEANS — Telehealth is safe, satisfactory and cost-effective for treatment of non-displaced pediatric elbow fractures, according to a presenter here.

“Telehealth in this particular scenario appears to be safe. There was no sign of fracture displacement, and they had similar function and pain scores,” Mauricio Silva, MD, said at the American Academy of Orthopaedic Surgeons Annual Meeting. “However, patients in the telehealth group had [a] higher satisfaction rate and spent only one-third of the time for their clinical encounter, or one-seventh if the travel time was included.”

Silva and colleagues identified 54 consecutive children with type 1 supracondylar humeral fractures or occult, acute elbow injuries. All patients were first treated with a long-arm, soft fiberglass cast. Investigators categorized 27 patients into group A, which had their cast removed by a staff member, and 27 patients into group B, which had a telehealth appointment through a two-way videoconferencing system and then a parent removed the cast. At week 8, both groups returned to the institution for a final follow-up. The groups were compared for the amount of fracture displacement, recovery of range of motion, pain, satisfaction, length of 4-week clinical encounter and professional fee for the particular visit.

At the 8-week follow-up, minimal changes were seen in elbows from both treatment groups compared with normal, contralateral elbows. Both groups had similar mean of arm motion and achieved an identical relative arc of motion compared with the normal, contralateral side. Investigators noted the groups had low pain scores at 4-week and 8-week appointments. At 4 weeks, the scores were clinically similar despite statistical significance.

At the time of cast removal, patient satisfaction for group A was 71% and was 100% for group B. The mean length of the 4-week clinical encounter for group A was 51 minutes and was 16 minutes for group B. Time to clinical encounter was 114 minutes and 16 minutes, respectively, for the groups when the time of travel from home to the institution was included. The 4-week mean professional fee for the clinical encounter for group A was $231 and was $185 for group B.– by Monica Jaramillo

Reference:

Silva M, et al. Paper #247. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 6-10, 2018; New Orleans.

Disclosure: Silva reports he is on the editorial or governing board for the Journal of Hemophilia.