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Background The coronavirus disease 2019 (COVID-19) has presented orthopaedic departments around the world with unprecedented challenges across all aspects of health care service delivery. This study explores the effect of the COVID-19 lockdown on trauma admissions and trauma theater utilization at a London District General Hospital. Methods Data was collected retrospectively from electronic patient records for 4 weeks from the initiation of two lockdown periods beginning March 16, 2020 and December 23, 2020. Results were compared with a comparable time period in 2019. Patient age, date of admission, time of admission, date of operation, length of stay, length of operation, type of operation, and length of anesthesia were analyzed. Results Fewer patients were admitted during the COVID-19 period for trauma (108 in 2019 vs. 65 in March 2020 and 77 in December 2020). In addition, there was a significant shift in patient demographics, with the mean age of patients being 55.6 years in 2019 and 64.1 years in March 2020 and December 2020 (p = 0.038). The most common mechanism of injury in both years was due to falls; however, the proportion of injuries due to falls fell from 75% in 2019 to 62% March 2020, but not significant change from pre-COVID baseline in December 2020 (77% falls). The duration of anesthesia was significantly longer in March 2020 (136 minutes) compared with in 2019 (83 minutes) (p < 0.00001). There was no statistically significant difference in operation length for each operation type, but there was an overall increase in median operation length of 13.6% in March 2020 from the previous year. Finally, although overall length of stay was roughly constant, the time between admission and operation was significantly reduced in March 2020 (1.22 vs. 4.74 days, p < 0.0000001). Conclusion Orthopaedic trauma remains an essential service which has always had to overcome the challenges of capacity and resources in busy cities like London. Despite the reduction in trauma volume during the COVID-19 lockdown there have still been significant pressures on the health care system due to new challenges in the face of this new disease. By understanding the effects of the lifestyle restrictions brought about by the lockdown on trauma services as well as the impact of COVID-19 on service delivery measures such as length of surgery and stay, health care managers can plan for service delivery in the future as we attempt to return to nonemergency orthopaedic services and move lockdown restrictions are eased.

Aims To establish the survivorship, function, and metal ion levels in an unselected series of metal-on-metal hip resurfacing arthroplasties (HRAs) performed by a non-designer surgeon. Methods We reviewed 105 consecutive HRAs in 83 patients, performed by a single surgeon, at a mean follow-up of 14.9 years (9.3 to 19.1). The cohort included 45 male and 38 female patients, with a mean age of 49.5 years (SD 12.5) Results At the time of review 13 patients with 15 hips had died from causes unrelated to the hip operation, and 14 hips had undergone revision surgery, giving an overall survival rate of rate of 86.7% (95% confidence interval (CI) 84.2 to 89.1). The survival rate in men was 97.7% (95% CI 96.3 to 98.9) and in women was 73.4% (95% CI 70.6 to 75.1). The median head size of the failed group was 42 mm (interquartile range (IQR) 42 to 44), and in the surviving group was 50 mm (IQR 46 to 50). In all, 13 of the 14 revised hips had a femoral component measuring ≤ 46 mm. The mean blood levels of cobalt and chromium ions were 26.6 nmol/l (SD 24.5) and 30.6 nmol/l (SD 15.3), respectively. No metal ion levels exceeded the safe limit. The mean Oxford Hip Score was 41.5 (SD 8.9) and Harris Hip Score was 89.9 (14.8). In the surviving group, four patients had radiolucent lines around the stem of the femoral component, and one had lysis around the acetabular component; eight hips demonstrated heterotopic ossification. Conclusion Our results confirm the existing understanding that HRA provides good long-term survival and function in patients with adequate-sized femoral heads. This is evidenced by a 97.7% survival rate among men (larger heads) in our series at a mean follow-up of 14.9 years. Failure is closely related to head sizes ≤ 46 cm. Cite this article: Bone Jt Open 2022;3(1):68–76.

Traumatic injuries are a global health problem. Most first world countries have developed comprehensive trauma systems to provide optimal care for injured patients. A trauma system is a coordinated effort in a defined geographic area that attempts to deliver trauma care to all injured patients and is usually integrated with the local public health system. The majority of low and middle income countries (LMIC) do not have functional trauma systems. This study aims to critique the status of trauma care in Nigeria and make a case for a re-organisation towards an inclusive trauma system. The methodology was a review of published articles and available grey literature to assess current practices in Nigeria within the various components of a trauma system, viz., injury prevention, pre-hospital care, acute care, and rehabilitation. The conclusions from this review suggest that integrating existing major trauma centres (MTCs) with smaller local hospitals within a region into an inclusive, interconnected region-based trauma system is the cheapest and most efficient way to improve Nigeria's trauma care and significantly reduce trauma mortality rates.