This study aimed to compare the treatment pathway and 30-day outcomes of hip fracture patients admitted during the COVID-19 pandemic with the pre-pandemic period. Three periods were retrospectively analysed:

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IntroductionMechanical instability in the lumbar spine is a term often used to describe an altered pattern of segmental movement causing pain. This is usually due to degenerative disease. Historically, symptoms of mechanical instability have been treated surgically with spinal fusion.In an attempt to modify the movement pattern of an abnormal motion segment, the Graf ligament system was introduced. It consists of modified titanium pedicle screws inter-connected with bands of braided polypropylene. This arrangement attempts to recreate the lumbar lordosis and allows limited movement to occur, hence the concept of 'flexible intervertebral stabilisation'. The operation is quicker, less destructive and requires less rehabilitation than a definitive spinal fusion.Previous authors [3,4,7] have reviewed early results of the system, which have been encouraging. We reviewed over 50 patients who underwent this procedure with an average follow-up time of over 5 years. Patients and methodsWe retrospectively reviewed 69 patients who underwent Graf ligament stabilisation between 1993 and 1997. Of these, 51 patients were available for follow-up. There were 23 women and 28 men. The mean age was 41 years (range, 22-67 years). All patients had chronic low back pain. Eight patients had had previous spinal surgery in the form of discectomy. Conservative management of back pain had failed in all the patients. This included physiotherapy, epidurals and facet joint injection. All patients were assessed preoperatively with an Oswestry Disability Index for low back pain. Our indication for stabilisation with the Graf ligament was intractable low back pain for which conservative measures of treatment had failed. All patients had magnetic resonance imaging (MRI) or computed tomography (CT) scans. Abnormal degenerative discs, end-plate changes or marked facet degeneration were targeted for stabilisation. Patients with equivocal scans were further investigated using discography. The surgery was performed by the two senior authors (M.A.F. and A.J.B.F.) exclusively. Fifteen patients had significant leg pain with clinical and radiological signs of nerve root entrapment and consequently underwent nerve root decompression at the same time as the spinal stabilisation. The majority of patients (n=31) had single-level stabilisation, while 17 had two-level and 3 had three-level stabilisation.Patient notes were examined. Previous history and details of surgery were recorded. Post-operative complications and length of Abstract Previous studies have looked at early follow-up of the Graf ligament stabilisation system. We present mid-to long-term results of this procedure. A retrospective review of Graf ligaments inserted since 1993 was undertaken. A total of 51 patients were reviewed. Pre-operative Oswestry Disability Index scores were compared to post-operative scores recorded via a postal questionnaire. There were 28 men and 23 women. The average age was 41 years (range, 22-67 years). The mean pre-operative score was 46 (range, 22-78), the mean follow...

Introduction The COVID-19 pandemic presented extraordinary challenges to the UK healthcare system. This study aimed to assess the impact of the COVID-19 lockdown on the epidemiology, treatment pathways and 30-day mortality rates of hip fractures. Outcomes of COVID-19 positive patients were compared against those who tested negative. Methods An observational, retrospective, multicentre study was conducted across six hospitals in the South East of England. Data were retrieved from the National Hip Fracture Database and electronic medical records. Data was collected for the strictest UK lockdown period (period B=23 March 2020–11 May 2020), and the corresponding period in 2019 (period A). Results A total of 386 patients were admitted during period A, whereas 381 were admitted during period B. Despite the suspension of the ‘Best Practice Tariff’ during period B, time to surgery, time to orthogeriatric assessment, and 30-day mortality were similar between period A and B. The length of inpatient stay was significantly shorter during period B (11.5 days vs 17.0 days, p<0.001). Comparison of COVID-19 positive and negative patients during period B demonstrated that a positive test was associated with a significantly higher rate of 30-day mortality (53.6% vs 6.7%), surgical delay >36h (46.4% vs 30.8%, p=0.049), and increased length of inpatient stay (15.8 vs 11.7 days, p=0.015). Conclusions The COVID-19 lockdown did not alter the epidemiology of hip fractures. A substantially higher mortality rate was observed among patients with a COVID-19 positive test. These findings should be taken into consideration by the healthcare policymakers while formulating contingency plans for a potential ‘second wave’.