Remote telementoring leads to orthotrauma and orthoplastic surgical plan creation independence during a humanitarian crisis

Background: To determine whether remote telementoring enables the surgical plan creation independence for complex care during a humanitarian crisis. Methods: A senior mentoring team partnered with an orthopedic traumatologist team at a Ukrainian civilian hospital treating complex war-injured patients. Initially, biweekly and then weekly teleconsultations were conducted to evaluate patients and address their care. Digital platforms supported communication and data storage. Excel® was used to house prospectively entered data. Data were explored using descriptive statistics (counts, percentages, means ± SD). Time frame-based frequencies were compared using Chi-square; significance was set at P < 0.05. Results: Telementoring consultations (135) occurred (1 April 2022 to 12 November 2024) for 222 patients (85% military and 15% civilian). Patients were male (89%) with a mean age of 37.8 ± 14.8 years. Injured regions included thigh (24.8%), ankle (24.8%), wrist (21.2%), and hand (21.2%). Injuries involved bone (93.4%), joint (76.6%), and soft tissue (70.1%), with infection in 36.5%. Consultation addressed decision-making (97.8%), OR plans (98.5%), implants (31.3%), rehabilitation (32.1%), antibiotics (21.9%), and cultures (18.2%). Procedure recommendations were redebridement (48.1%), ORIF (27%), NPWT (22.6%), local flap (22.6%), intramedullary nail (20.4%), external fixator removal (18.9%), free flap (15.3%), and bone grafting (13.8%); amputation was uncommon (10.9%). Ukrainian surgeons advanced from needing a plan to only needing affirmation or minor modification by patient 136 (61.2% of patient flow, June 2023). Free flap recommendations increased after plan independence (3 before vs. 18 after, P < 0.01). Conclusions: Remote telementoring develops local expertise (decision-making, operative planning, and complication management) for complex, injured patients. Complex planning is supported by a stable consultant group that fosters durable relationships.