When Lachlan fractured his elbow, he dreaded a hospital trip. This is how he managed to avoid it

The Sydney researchers behind a world-first study into virtual fracture care say the innovative service could ease pressure on increasingly strained hospitals and revolutionise care for one of Australia’s most common injuries – the broken bone.

Orthopaedic clinics have the highest attendance of any outpatient service in Australia, while fractures remain the most common type of injury recorded in emergency department presentations, with almost 407,000 cases nationwide in 2024-25 alone.

Yet when Lachlan Peden broke his elbow playing social netball last week, he managed to skip the hospital altogether.

After colliding with a teammate half his size – who “came off scot-free” – Peden attended his local urgent care clinic and radiology service, avoiding a lengthy wait in an emergency department, before being referred to Royal Prince Alfred Hospital’s virtual fracture clinic for follow-up care.

“I thought it was great because … having to go to a follow-up [appointment], get in the car, sit in the waiting room, do these exercises, that’s half your day,” Peden said.

“Honestly, if I had to go to an in-person appointment, I probably would have just said: I’m not going to bother.”

Sydney Virtual Hospital, formerly RPA Virtual Hospital, was Australia’s first, and its virtual fracture clinic was the first of its kind in NSW when it was launched in 2020.

While similar services exist elsewhere, a new study – published in The Lancet journal eClinicalMedicine on Wednesday – is the first randomised controlled trial in the world to test whether a virtual fracture clinic can provide similar outcomes to standard in-person care.

The RECITAL trial compared patient outcomes at the physiotherapist-led virtual clinic against an orthopaedic surgeon-led, in-person clinic.

It found adults with a simple fracture who did not require surgery or a plaster cast had similar or improved outcomes at the virtual clinic.

At 12 weeks, patients in the virtual care group had a mean physical function score 0.5 points higher than the in-person group, reported fewer adverse events (such as unplanned hospitalisations) and had a higher patient experience rating in all categories.

“This was a remarkable finding,” said the study’s lead author Min Jiat Teng, who is a PhD candidate at the University of Sydney’s Institute for Musculoskeletal Health.

“We initially expected the virtual care group would have as good as usual outcomes, but instead we found they had better outcomes than the in-person care group.”

Teng estimated this was because virtual patients had longer and more frequent assessments: In a typical appointment, a physiotherapist might explain X-ray results, the nature of the injury, and a care management plan, as well as demonstrating a series of exercises, which the participant would trial during the video call.

“Whereas at an in-person clinic, you would travel all the way to the hospital, find a car park here in the inner-west of Sydney – which is difficult – wait for probably about half an hour or an hour, just to see a surgeon for about five to 10 minutes,” he said.

Ian Harris, a professor of orthopaedic surgery at the University of NSW who did not participate in the research, said the study provided important scientific evidence on the value of virtual clinics.

“Hospital care has been very slow to modernise, and this is an obvious area where we can make it a lot easier for patients … it’s a much more efficient way of delivering care.”

While some patients reported problems with internet connectivity or with understanding how to angle their camera, participants could be referred on to an in-person clinic if they couldn’t be safely assessed via video.

During the trial, about 8 per cent of the virtual care group had their care escalated to the in-person clinic.

Royal Australian College of Surgeons fellow Dr Andrew Ellis also backed the trial and said virtual clinics were a positive step in the evolution of healthcare: “For every dollar we spend, we’ve got to think of the dollar we can save.”

Cost-saving analysis from the study is yet to be published, but Teng anticipated virtual fracture clinics could deliver significant savings to both patients and to the healthcare system overall.

Teng, who also practices at the virtual care clinic, said the program could have particular impact on regional and rural communities, and he hoped to see the virtual care model expanded across NSW.

“We’re not going to conquer the world and shut down in-person clinics,” he said.

“However, if we can offload patients from in-person clinics, from the emergency department, and patients are reporting better experiences with care because they don’t need to sit there and wait while in pain … that’s where this is going to work.”

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