CORR Synthesis: What Evidence Is Available for the Continued Use of Telemedicine in Orthopaedic Surgery in the Post-COVID-19 Era?

The first documented use of telemedicine in orthopaedic surgery was in 1993 between video teleconferencing centers at Tripler Army Medical Center in Oahu, Hawaii and the Kwajalein Atoll in the Republic of theMarshall Islands, connecting two archipelagoes separated by 2200 nautical miles and demonstrating for the first time that telemedicine could be used to provide orthopaedic specialty care across geographical distances [18]. Since then, telemedicine has been used in several aspects of orthopaedic practice, such as remote consultations, postoperative follow-up and rehabilitation, but is not yet standard practice [11, 35, 43, 46]. The most well-established use of telemedicine in orthopaedics is the virtual fracture clinic, pioneered by theGlasgow Royal Infirmary [54]. Standardized, evidence-based protocols are used for a number of stable fractures, and allow many patients to be discharged directly from the emergency department [9, 23, 25, 33, 54]. Patients who might benefit from specialty review are referred to the virtual fracture clinic, where their patient notes and radiographs are reviewed electronically the following day by a multidisciplinary team. Patients then are either discharged directly from the virtual fracture clinic with telephone advice or attend a face-to-face clinic for further review. This has proved to be a clinically acceptable pathway for managing stable injuries and is now used in many orthopaedic departments across the United Kingdom and internationally [32]. The coronavirus disease 2019 (COVID-19) pandemic has forced us to rethink the way that we provide orthopaedic trauma care and new departmental policies have been drawn [1, 7]. Changes initiated by orthopaedic and other surgical specialties are based on guidelines published by the British Association of Oral and Maxillofacial Surgeons in response to the specialties’ high exposure risks [6]. These guidelines aim to reduce the spread of the virus according to four basic principles: personal protective equipment, avoid (contact and transfer of patients), restrict (the number of visits and generation of aerosols), and abbreviate (waiting times and treatment). A critical manifestation of this change has been the rapid extension of telemedicine into many aspects of orthopaedic practice [37, 50]. Video conferencing platforms have allowed departments to perform electronic video consultations for Both authors certify that neither he nor she, nor any members of his or her immediate family, has any commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request. Clinical Orthopaedics and Related Research® neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use. The opinions expressed are those of the writers, and do not reflect the opinion or policy of CORR® or The Association of Bone and Joint Surgeons®.