Related Experiment Video
Updated: Nov 1, 2025
Minimally Invasive Treatment for Thoracolumbar Burst Fracture Using Sagittal Alignment Screws and A Trauma Reduction Device
Published on: November 8, 2024
What Can We Learn From COVID-19 Protocols With Regard to Management of Nonoperative Pediatric Orthopaedic Injuries?
Graeme E Hancock1, Ian Baxter, Vivek Balachandar
1Department of Trauma and Orthopaedics, Sheffield Children's NHS Foundation Trust, Sheffield Children's Hospital, Sheffield, UK.
Insights
COVID-19 pandemic changes in pediatric orthopaedics, including telephone appointments and self-removable casts, were safe short-term. These practices reduced patient visits and costs without increasing complications.
Area of Science:
- Pediatric Orthopaedics
- Trauma Care
- Public Health
Background:
- The COVID-19 pandemic necessitated significant adaptations in pediatric orthopaedic outpatient services.
- Key changes included the implementation of telephone consultations and the adoption of self-removable casting techniques.
Purpose of the Study:
- To evaluate the short-term safety and efficacy of modified pediatric orthopaedic trauma care practices during the COVID-19 pandemic.
- To assess the impact of these changes on patient outcomes, appointment frequency, and resource utilization.
Main Methods:
- A retrospective comparative study analyzed patients referred to fracture clinic during the March 24 to May 10, 2020 lockdown period.
- Data on appointments, radiographs, discharge times, casting methods, and complications were compared to the same period in 2019.
- Follow-up extended to six months for all patients.
Main Results:
- Fewer face-to-face appointments and radiographs per patient were observed in 2020 compared to 2019, with a significant increase in telephone appointments.
- Time to discharge was significantly reduced in 2020.
- The use of self-removable casting increased dramatically from 2.4% to 91.8%, with no significant difference in complication rates for various fracture types.
- Significant cost savings were identified, exceeding £185,000 annually, due to reduced appointments and cast removals.
Conclusions:
- Modified pediatric orthopaedic trauma management during the pandemic proved safe in the short term, showing no increase in complications.
- These adapted practices offer potential cost savings for healthcare providers and patients.
- The feasibility of continuing these beneficial and safe practices post-pandemic is supported.
Introduction:
The COVID-19 pandemic has resulted in significant changes to normal practice in pediatric outpatient orthopaedics, with the instigation of telephone fracture clinic appointments, and the use of self-removable casting. We aim to determine any beneficial or detrimental short-term effects of these changes.
Methods:
All patients referred to fracture clinic from the emergency department during the period March 24, 2020 to May 10, 2020 (national lockdown) were assessed for number of face to face and telephone appointments, number of radiographs performed, time to discharge, use of a removable cast, any cast complications, other complications, reattendance or re-referral after discharge. They were compared with patients referred in the same period in 2019. Follow-up was to 6 months for every patient.
Results:
In 2019, 240 patients were reviewed and 110 in 2020. Changes in practice resulted in significant differences in the number of face to face appointments per patient [2 (1 to 6) 2019 vs. 1 (0 to 5) 2020 (P<0.00001)] and increase in telephone appointments [0 (0 to 1) 2019 vs. 1 (0 to 2) 2020]. Number of radiographs per patient [1 (1 to 7) 2019 vs. 1 (1 to ) 2020 (P=0.0178)] and time to discharge [29 d (0 to 483) 2019 vs. 16 d (0 to 216) 2020 (P<0.00001)] also reduced significantly. Use of a self-removable casting technique increased significantly (2.4% of casts in 2019 vs. 91.8% in 2020 (P<0.00001). There were no significant differences in complications related to cast or otherwise, unplanned attendance or reattendance after discharge. Use of self-removable casts for supracondylar fractures and for simple injuries (including distal radius, forearm, Toddler's, and ankle fractures) also demonstrated no change in complication rate. Significant potential cost savings of >£185 000 per annum could be demonstrated through clinic appointment and cast removal reductions.
Discussion:
Changes to the normal management of pediatric orthopaedic trauma brought about by the COVID-19 pandemic have been demonstrated to be safe in the short term with no increase in complications demonstrated. Potential cost savings are possible both to the health care provider and also to the patient because of reduced hospital attendance. It is feasible to continue these practices for the potential benefits as they appear safe in the short term.
Level Of Evidence:
Level III-therapeutic study-retrospective comparative study.
Related Concept Videos
01:27Fractures: Bone Repair
Minor fractures with no bone displacement are treated by immobilizing the fractured bone using a cast or splint. However, in the case of fractures with displaced bones, the broken bones are repositioned before immobilization to ensure successful healing without deformation and loss of function. The realignment of fractured bone ends is performed through a process called reduction. If the...
01:26Tonsillitis II: Management
01:28Cardiomyopathy VII: Pre and Post Operative Nursing Management
01:26Standard Precaution
Hand hygiene is the most crucial means to prevent the transmission of disease. Employers are legally required to provide their workers with personal protective equipment (PPE) to minimize exposure or contact with...
01:22Aneurysm IV: Nursing Management
01:25Transmission-based Precautions II: Airborne and Protective Environment
Airborne precautions:
Use airborne precautions when treating patients known or suspected to have diseases that spread through the air—for example, tuberculosis or measles. These organisms are present in smaller droplets expelled by an infected person and...