The theoretical impact on corrective upper limb elective services following analysis of distal radius fractures managed nonoperatively during COVID-19 pandemic

Abstract

Aims To assess the proportion of patients with distal radius fractures (DRFs) who were managed nonoperatively during the COVID-19 pandemic in accordance with the British Orthopaedic Association BOAST COVID-19 guidelines, who would have otherwise been considered for an operative intervention. Methods We retrospectively reviewed the radiographs and clinical notes of all patients with DRFs managed nonoperatively, following the publication of the BOAST COVID-19 guidelines on the management of urgent trauma between 26 March and 18 May 2020. Radiological parameters including radial height, radial inclination, intra-articular step-off, and volar tilt from post-reduction or post-application of cast radiographs were measured. The assumption was that if one radiological parameter exceeds the acceptable criteria, the patient would have been considered for an operative intervention in pre-COVID times. Results Overall, 92 patients formed the cohort of this study with a mean age of 66 years (21 to 96); 84% (n = 77) were female and 16% (n = 15) were male. In total, 54% (n = 50) of patients met at least one radiological indication for operative intervention with a mean age of 68 years (21 to 96). Of these, 42% (n = 21) were aged < 65 years and 58% (29) were aged ≥ 65 years. Conclusion More than half of all DRFs managed nonoperatively during the COVID-19 pandemic had at least one radiological indication to be considered for operative management pre-COVID. We anticipate a proportion of these cases will require corrective surgery in the future, which increases the load on corrective upper limb elective services. This should be accounted for when planning an exit strategy and the restart of elective surgery services. Cite this article: Bone Joint Open 2020;1-10:612–616.

Epidemiology of distal radius fractures in children and adults during the COVID-19 pandemic – a two-center study

“…The COVID-19 pandemic altered the healthcare in the whole world in the year 2020 [13][14][15][16][17][18][19][20][21][22][23][24][25][26]. Although the causative coronavirus (SARS-CoV-2) can infect both adults and children, the majority of children have mild or asymptomatic course of the disease [13].…”

“…Despite having suffered an injury, some patients, particularly the elderly and those with comorbidities, have avoided seeking medical help at emergency or trauma and orthopedic wards due to the fear of contracting COVID-19 [13,22]. In order to increase the safety of the medical personnel and reduce the number of admitted and operated patients, some hospitals increased the number of indications for conservative treatment of injuries and postponing surgery [25,26].…”

“…DRF can be treated surgically with various stabilization methods and non-surgically in plaster [2,6,7,[9][10][11]25]. The British Orthopedic Association (BOA) recommends non-surgical treatment of DRF during the COVID-19 pandemic.…”

“…The British Orthopedic Association (BOA) recommends non-surgical treatment of DRF during the COVID-19 pandemic. The guidelines accept in some patients the possibility of complications and deformity, that will require deferred surger [25]. The goal of treating injuries during the COVID-19 pandemic is rapid and safe treatment [25].…”

“…The reduction of the number of patients treated surgically with DRF during the COVID-19 pandemic may have consequences in the form of more complications in the future [25,26]. Surgical treatment of DRF is indicated especially in young patients with dislocated, multi-fragmented and intra-articular fractures.…”