Visual estimation of joint angles at the elbow

The aim of this study was to assess the accuracy of visual estimation of elbow joint angles. A total of 116observers (93 doctors and 23 physiotherapists) were shown 21 digital images of two arms in predeWned degrees of elbow Xexion on two separate occasions. They estimated the angle of Xexion to the nearest 5°. Only 70.8% of estimates were within +5°, although intra-observer agreement was good among all groups tested (ICC range 0.963-0.983). Orthopaedic consultants and registrars were equivalent and statistically better at estimating the angles compared to senior house officers and physiotherapists (P < 0.001). Compared to the angles of 85 and 90°, all other angles were signifcantly less likely to be estimated to within +5° (P < 0.001). In conclusion, visual estimation of joint angles at the elbow may not be desirable in cases where accurate serial assessment is required for clinical decision making. The use of a goniometer by an agreed standardized protocol is advised

Fracture clinic redesign reduces the cost of outpatient orthopaedic trauma care

Objectives: “Virtual fracture clinics” have been reported as a safe and effective alternative to the traditional fracture clinic. Robust protocols are used to identify cases that do not require further review, with the remainder triaged to the most appropriate subspecialist at the optimum time for review. The objective of this study was to perform a “top-down” analysis of the cost effectiveness of this virtual fracture clinic pathway. Methods: National Health Service financial returns relating to our institution were examined for the time period 2009 to 2014 which spanned the service redesign. Results: The total staffing costs rose by 4% over the time period (from £1 744 933 to £1 811 301) compared with a national increase of 16%. The total outpatient department rate of attendance fell by 15% compared with a national fall of 5%. Had our local costs increased in line with the national average, an excess expenditure of £212 705 would have been required for staffing costs. Conclusions: The virtual fracture clinic system was associated with less overall use of staff resources in comparison to national cost data. Adoption of this system nationally may have the potential to achieve significant cost savings