To wait for virtual Fracture Clinic

[RichmondMumof2]

My daughter (7YO) fell from monkey bars on Wednesday with an outstretched arm. Based on her distress we visited the acute trauma unit at the local hospital where the radiographer mentioned a distal humerus fracture, luckily not in growth plate area.

Several hours more waiting than we were given a leaflet for a Virtual Fracture Clinic and sent home with paracetamol. They called a few hours later and clarified that someone will call us on Monday (5 days later) and that was it. No sling, no nothing.

Has anyone else experienced this? Should I be taking her to a different hospital where A&E have a neighbouring fracture clinic?

I’m feeling very fobbed off and like I’m not being a good parent by advocating something more assertive. Can leaving a broken elbow for 5 days cause more problems?

Well, I’ve done a quick Google and as a result I would definitely be demanding a second opinion as a matter of urgency.
Apparently a lot of those type of fractures need surgery, and are very painful.

What the hell is a virtual fracture clinic?! How can they do anything to a bone over the phone? I’d be going for a second opinion!

It’s too late now wait for a call tomorrow from the virtual fracture clinic if she is managing the pain.

Link here to some more information
Info about treatment of this type of fracture in children

Virtual fracture clinics are commonplace in most hospital trusts. If you think they need a sling for symptom relief in the meantime then pop back to A&E.

This sounds very strange, were you not assessed by a nurse practitioner?
It is not the role of a radiographer to diagnose injuries
Teddington is a minor injuries unit not a trauma centre. Is it possible there was some confusion?
You definitely need to speak to someone if only to clarify the diagnosis and pathway

I wouldn’t be pleased. DS fractured his elbow and needed surgery. They did send him home with a bandaged arm and a sling with a date for surgery after the weekend. I was told the surgery would be easier once swelling had subsided a little. Possibly a different type of break but he needed a plate and screws.

In case it comes to it, they needed to remove the plate afterwards as could of affected the growth plate so we had to redo trauma/ healing months after the original injury.

How is the pain I’d certainly contact 111 and ask for advice re support.

I fractured my elbow a couple of years ago. I was lucky it was minor and didn't require surgery as they said elbows often do when it's a bigger break. However I was still given a sling to wear for the first few days for comfort and would have really struggled without it. They did say it was important to try and mobilise joint fractures as soon as possible and have periods without the sling asap. I also had a call from the fractured clinic and wasn't seen in person. Doe she seem in a lot of pain still OP?

This is part of a new Telimedicine initiative to improve wait times. This should be a FaceTime kind of call and they can decide there what’s needed. I would give her some ibuprofen as well as paracetamol to help with the pain. I’d also visit the pharmacy for a sling because that’s going to hurt a lot more leaving it hanging

Thank you all for the insightful responses. I’m hoping the fracture is like @Worriedmum40284’s.

Apologies @ChocHotolate it was Teddington Memorial Urgent Treatment Centre (UTC) not trauma unit. I hadn’t appreciated the difference and I guess that is the crux of this post. As soon as I suspected a broken arm I did call 111, spent 10 minutes explaining the situation and asked where to go and told I’d be called back within an hour with the answer to that simple question. I put my scarf on my daughter to fashion a sling and we headed to Teddington as it was closest. They did call back after an hour as we were waiting to be seen at Teddington and simply said get to an UTU and that I was fine at Teddington. I wonder if the outcome would have been different had I gone to Kingston / West Mid / C&W or would they all have said the same, go home and wait for a VFC call in 5 days.

A nurse practitioner did see us after some time and filled in the x-ray request following examination and also told the outcome of the x-ray in very basic terms ‘yes, there is a fracture’. I’m not here to criticise anyone but I felt very much the message was ‘someone will look at the x-rays and call you on Monday’ rather than any sort of diagnosis. The radiographer was just doing his job and seemed to share slightly more info.

I guess my question is, should I have gone straight to Kingston West Mid / Chelsea and Westminster A&E and would I have had a different outcome as they have fracture clinics on site?

We are keeping on top of the pain with neurofen and my daughter is doing really well. Unless she moves it there is no pain. She has strong don’t come near me vibes, which is healthy. She is still wearing the same jumper and my scarf as a sling in a position where she is comfortable. Red bruising appeared two days ago and seems to be yellowing.

Just to clarify I can get near her and she is out and about but just don’t come near my arm.

Our local hospital has fracture clinic etc on sore and they still do the same, you are sent home and given an appt x days later with the fracture clinic, so don’t doubt it would make a difference. I think if it were something requiring urgent surgery (ie bleeding/nerve impingement etc) they would have referred to Kingston straight away.

I nominated the VFC at West Mid and was given the choice.

Thank you @GayPareeee that is just what I was after. Knowing that it is the correct process.

If your daughter is in pain, and won't let you near the arm, and it hasn't been strapped up, I would go to an urgent care centre so she can be made comfortable.

She is not in pain unless she moves her arm from the scarf sling. So in effect it is immobilised.

I've been to that clinic many times with the kids. They are usually excellent. Someone from west mid reviews the fractures. Friend of ours fell off their bike and went there with an elbow fracture and after the X-ray, was immediately sent to West Mid for an operation so hopefully they would have picked it up already if it was serious.

Maybe go back there if you are worried about whether she needs a sling or not? I'm sure they would help if you did.

I work on a paediatric orthopaedic ward and have never heard of such a thing!

there's not much they can 'do to a bone' in a clinic room either though is there?

Here's the UCL leaflet on them

https://www.uclh.nhs.uk/application/files/1516/8069/9245/VirtualFractureeClinicMarchh2023.pdf