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The effects of a UK lockdown on orthopaedic trauma admissions and surgical cases: A multicentre comparative study
Matthew Hampton1, Matthew Clark1, Ian Baxter2
1Trauma and Orthopaedics, Rotherham General Hospitals NHS Trust, Rotherham, UK.
Insights
The UK COVID-19 lockdown significantly reduced overall trauma admissions by over 50%, but fragility fractures remained constant. DIY-related hand injuries and associated nerve damage increased during this period.
Area of Science:
- Orthopaedic Surgery
- Trauma Surgery
- Public Health
Background:
- The COVID-19 pandemic necessitated a national lockdown in the UK, impacting healthcare services.
- Understanding the effects of lockdown on trauma injury patterns and management is crucial for health service planning.
Purpose of the Study:
- To assess the impact of the UK national lockdown on the incidence, mechanisms, and types of injuries.
- To evaluate changes in the management of trauma patients during the lockdown period.
Main Methods:
- A multicentre study involving major trauma centres and general hospitals.
- Data collected on patient demographics, injury mechanisms, and treatments.
- Comparison of trauma data from the two weeks before lockdown, during lockdown, and the same period in 2019.
Main Results:
- A 55.7% reduction in total accident and emergency attendances and a 53.7% decrease in trauma admissions during lockdown compared to 2019.
- Fragility fractures remained constant, while road traffic collisions became the most common cause of major trauma.
- A significant rise in DIY-related hand injuries (26% vs 8%), leading to increased nerve injuries and hand infections.
Conclusions:
- National lockdown dramatically reduced orthopaedic trauma admissions, with no change in fragility fractures requiring surgery.
- DIY-related hand injuries increased, resulting in a higher incidence of nerve injuries requiring intervention.
- Surgical capacity must be maintained for essential trauma cases during public health crises.
Aims:
The current global pandemic due to COVID-19 is generating significant burden on the health service in the UK. On 23 March 2020, the UK government issued requirements for a national lockdown. The aim of this multicentre study is to gain a greater understanding of the impact lockdown has had on the rates, mechanisms and types of injuries together with their management across a regional trauma service.
Methods:
Data was collected from an adult major trauma centre, paediatric major trauma centre, district general hospital, and a regional hand trauma unit. Data collection included patient demographics, injury mechanism, injury type and treatment required. Time periods studied corresponded with the two weeks leading up to lockdown in the UK, two weeks during lockdown, and the same two-week period in 2019.
Results:
There was a 55.7% (12,935 vs 5,733) reduction in total accident and emergency (A&E) attendances with a 53.7% (354 vs 164) reduction in trauma admissions during lockdown compared to 2019. The number of patients with fragility fractures requiring admission remained constant (32 patients in 2019 vs 31 patients during lockdown; p > 0.05). Road traffic collisions (57.1%, n = 8) were the commonest cause of major trauma admissions during lockdown. There was a significant increase in DIY related-hand injuries (26% (n = 13)) lockdown vs 8% (n = 11 in 2019, p = 0.006) during lockdown, which resulted in an increase in nerve injuries (12% (n = 6 in lockdown) vs 2.5% (n = 3 in 2019, p = 0.015) and hand infections (24% (n = 12) in lockdown vs 6.2% (n = 8) in 2019, p = 0.002).
Conclusion:
The national lockdown has dramatically reduced orthopaedic trauma admissions. The incidence of fragility fractures requiring surgery has not changed. Appropriate provision in theatres should remain in place to ensure these patients can be managed as a surgical priority. DIY-related hand injuries have increased which has led to an increased in nerve injuries requiring intervention.
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