Background To review the clinical outcomes of all patients undergoing emergency orthopaedic trauma surgery at a UK major trauma centre during the first 6 weeks of the COVID-19 related lockdown. Methods A retrospective review was performed of all patients who underwent emergency orthopaedic trauma surgery at a single urban major trauma centre over the first six-week period of national lockdown. Demographics, co-morbidities, injuries, injury severity scores, surgery, COVID-19 status, complications and mortalities were analysed. Results A total of 76 patients were included for review who underwent multiple procedures. Significant co-morbidity was present in 72%. The overall COVID-19 infection rate of the study population at any time was 22%. Sub-group analysis indicated 13% had active COVID-19 at the time of surgery. Only 4% of patients developed COVID-19 post surgery with no mortalities in this sub-group. The overall mortality rate was 4%. The overall complication rate was 14%. However mortality and complications rates were higher if the patients had active COVID-19 at surgery, if they were over 70 years and had sustained life-threatening injuries. Conclusion The overall survival rate for patients undergoing emergency orthopaedic trauma surgery during the COVID-19 peak was 96%. The rate of any complication was more significant in those presenting with active COVID-19 infections who had sustained potentially life threatening injuries and were over 70 years of age. Conversely those without active COVID-19 infection and who lacked significant co-morbidities experienced a lower complication and mortality rate.
Introduction Non-injury-related factors have been extensively studied in major trauma and have been shown to have a significant impact on patient outcomes. Mental illness and associated medication use has been proven to have a negative effect on bone health and fracture healing. Materials and methods We collated data retrospectively from the records of orthopaedic inpatients in a non-COVID and COVID period. We analysed demographic data, referral and admission numbers, orthopaedic injuries, surgery performed and patient comorbidities, including psychiatric history. Results There were 824 orthopaedic referrals and 358 admissions (six/day) in the non-COVID period, with 38/358 (10.6%) admissions having a psychiatric diagnosis and 30/358 (8.4%) also having a fracture. This was compared with 473 referrals and 195 admissions (three/day) in the COVID period, with 73/195 (37.4%) admissions having a documented psychiatric diagnosis and 47/195 (24.1%) having a fracture. Discussion There was a reduction in the number of admissions and referrals during the pandemic, but a simultaneous three-fold rise in admissions with a psychiatric diagnosis. The proportion of patients with both a fracture and a psychiatric diagnosis more than doubled and the number of patients presenting due to a traumatic suicide attempt almost tripled. Conclusion While total numbers using the orthopaedic service decreased, the impact of the pandemic and lockdown disproportionately affects those with mental health problems, a group already at higher risk of poorer functional outcomes and non-union. It is imperative that adequate support is in place for patients with vulnerable mental health during these periods, particularly as we look towards a potential ‘second wave’ of COVID-19.
Ankle fractures are a common injury. Assessment should include looking at the mechanism of injury, comorbidities, associated injuries, soft tissue status and neurovascular status. Emergent reduction is required for clinically deformed ankles. Investigations should include plain radiographs and a computed tomography scan for more complex injuries or those with posterior malleolus involvement. An assessment of ankle stability determines treatment, taking into account comorbidities and preoperative mobility which need special consideration. Non-operative management includes splint or cast, allowing for early weightbearing when the ankle is stable. Operative management includes open reduction and internal fixation, intramedullary nailing (of the fibula and hindfoot) and external fixation. Syndemosis stabilisation includes suture button or screw fixation. The aim of treatment is to restore ankle stability and this article explores the current evidence in best practice.
As both life expectancy and average population age continue to rise, so too does the incidence of cervical spine (c-spine) injuries. C-spine fractures are associated with high morbidity and mortality, but the question is how best to treat them? This review is to compare the safety and efficacy of c-spine immobilisation in a rigid collar with other treatment modalities in elderly population. Available literature was reviewed to determine how treatment efficacy is assessed, with particular focus on whether osseous union or fibrous non-bony union should be considered as a successful outcome. This study was designed in accordance with PRISMA guidelines. Pubmed/Medline databases were selected for analysis. When considering patients over the age of 65, it is unclear whether management with a collar is safer than operative management or immobilisation with HALO vest. However, amongst studies that further subdivide elderly patients according to age there is more of a consensus; it appears that in those under the age of 75, operative management is safer, whereas in those over the age of 85, immobilisation in a collar is associated with lower mortality rates. Between the ages of 75-85 there is less clarity. Osseous union occurs more commonly in patients managed operatively, but fibrous non-bony union was not associated with any adverse outcomes in these studies. Conclusion: At present, there are no randomised controlled trials that have tried to delineate whether management in a collar is safer or more effective than other treatments such as HALO vest or operative fixation. However, evidence from various cohort studies does suggest that "elderly" patients with c-spine fractures should not be considered as one homogenous cohort, but should instead be subdivided according to age. Interestingly, these studies suggest that fibrous non-bony union may be an adequate treatment outcome in older. Further research into this complex field is required.
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