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Hand Injuries During COVID-19 UK Lockdown: How Did the Pandemic Affect 1-Year Functional Outcomes?
Zeid Morcos1, Joe Barrett-Lee1, Fadi Hindi1
1Portsmouth Hospitals University NHS Trust, UK.
Insights
The COVID-19 lockdown reduced hand injury referrals by 68%, with shifts in injury types. Most patients managed conservatively in the virtual fracture clinic (VFC) had good outcomes and high satisfaction.
Area of Science:
- Orthopedics
- Trauma Surgery
- Public Health
Background:
- The COVID-19 pandemic led to a national lockdown in the UK in March 2020.
- This study evaluated the impact of lockdown on hand injuries managed via a virtual fracture clinic (VFC).
- Limited resources during lockdown necessitated an assessment of hand injury management and outcomes.
Purpose of the Study:
- To assess the effect of the UK COVID-19 lockdown on hand injury referrals to a VFC.
- To analyze changes in the types of hand injuries sustained during lockdown.
- To evaluate the management, complications, and functional outcomes of hand injuries during this period.
Main Methods:
- Analysis of hand injury referrals to Queen Alexandra Hospital's VFC during April-May 2020.
- Exclusion of isolated carpus and wrist injuries.
- Comparison with pre-lockdown and post-restriction periods.
- Functional outcomes assessed using the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score at 12 months.
Main Results:
- A 68% reduction in hand injury referrals during lockdown.
- Shift in injury patterns: fewer sports injuries, more falls and crush injuries.
- No increase in complications for conservatively managed hand fractures despite higher discharge rates from VFC.
- Eighty percent reported low QuickDASH scores (median 2.3), with 73% satisfied or very satisfied.
Conclusions:
- Hand trauma remains a significant issue during lockdowns, requiring adapted service provision.
- Conservative management in VFC is effective for most hand injuries.
- High patient satisfaction and low complication rates are achievable with VFC management during lockdowns.
Background:
The COVID-19 outbreak was declared a pandemic in March 2020, forcing the United Kingdom into a national lockdown. The aim was to evaluate the effect of this lockdown on hand injuries referred through the trauma and orthopedics virtual fracture clinic (VFC) service and their subsequent management given limited resources. This study also aimed to identify complications and evaluate functional outcomes.
Methods:
Patients referred through VFC at Queen Alexandra Hospital during April and May 2020 with hand injuries were analyzed. Isolated injuries to the carpus and wrist were excluded. Controls were compared over identical time spans prior to lockdown and after the restrictions were eased. Functional outcomes were measured using the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, at 12 months after injury.
Results:
There was a 68% reduction in referrals of hand injuries during lockdown. Lower numbers of sporting injuries were seen, in contrast to an increased rate of falls, crush injuries, and recreational cycling. Despite a higher number of patients being discharged from VFC during lockdown, there were no increased rates of complications from conservatively managed hand fractures. Eighty percent reported low QuickDASH scores with a median of 2.3. Satisfaction was high, with 73% either satisfied or very satisfied with their treatment and outcome.
Conclusion:
This study demonstrates that there remains a burden of hand trauma during lockdowns, and therefore, service provision for future lockdowns should consider this. Most patients can be managed conservatively, and a high proportion can be discharged from VFC with low complication rates and high satisfaction.
