The effects of a UK lockdown on orthopaedic trauma admissions and surgical cases

Abstract

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.

Impact of the Covid-19 lockdown period on adult musculoskeletal injuries and surgical management: a retrospective monocentric study

“…Surgical procedures were lower for all mechanisms, except for domestic injuries, which increased signi cantly between the pre-lockdown and the late lockdown period (29 (16.1%) vs. 33 (27.5%), p = .017). This has also been described by Hamptons et al and seems logical due to con nement measures (8); some of these injuries amounted to high severity trauma such as injuries sustained from a fall from a roof or a tree. The proportion of surgical indications for elderly fragility fractures remained equivalent for the pre-lockdown, early, and late lockdown periods, although the absolute numbers were halved compared to the pre-lockdown period.…”

“…A pronounced 52.1% decrease in weekly emergency department admissions between the pre-lockdown (415.3 ± 44.2) and the lockdown period (198.5 ± 46.0) was noted in our hospital (p < .001). The magnitude of this decrease is greater than the 36.9% decrease described by Hampton et al for a shorter 2-week period before and after a lockdown in Britain (8). Compared to 2018 and 2019, the decrease in emergency department musculoskeletal injuries admissions in the lockdown period in 2020 was decreased by 62.1 and 64%, respectively.…”

“…Nantes University Hospital is the primary referral center for major trauma, neurosurgery, and orthopaedics, with more than 125 000 emergency admissions and more than 45 000 surgeries per year in 2018 and a catchment area of more than 3.5 million people. There has been little quantitative or qualitative data to date regarding the impact of lockdown measures on emergency departments with a focus on surgical traumatology (8,9).…”

The Impact of COVID-19 on Interventional Radiology Services in the UK

“…National figures reported by Public Health England state 2.11 million Accident and Emergency (A&E) attendances in April 2019 compared to only 916,000 attendances in 2020, which represents some of the lowest figures in recent times [ 6 , 14 ]. A decrease in trauma admissions by 54% has also been observed in the UK [ 7 , 8 ]. Similarly, a survey of 43 UK centres reports that 36% of cardiac cath laboratories were also closed during the UK COVID-19 lockdown [ 9 ].…”

The global burden of trauma during the COVID-19 pandemic: A scoping review

“…The effects of the worldwide lockdown are yet to be fully understood; however research suggests that it has led to significant changes in the presentation of medical and surgical conditions, including changes in the aetiology of trauma 5 , late presentations of common conditions 6 , and higher surgical morbidity in surgical patients with concomitant COVID-19 infection 7 . Furthermore, COVID-19 fundamentally changed demand on healthcare services; with a proportionally higher demand on medical and critical care specialties compared to surgical specialities.…”