The impact of the COVID-19 lockdown on orthopaedic emergency presentations in a remote and rural population

Abstract

Aims COVID-19 remains the major focus of healthcare provision. Managing orthopaedic emergencies effectively, while at the same time protecting patients and staff, remains a challenge. We explore how the UK lockdown affected the rate, distribution, and type of orthopaedic emergency department (ED) presentations, using the same period in 2019 as reference. This article discusses considerations for the ED and trauma wards to help to maintain the safety of patients and healthcare providers with an emphasis on more remote geography. Methods The study was conducted from 23 March 2020 to 5 May 2020 during the full lockdown period (2020 group) and compared to the same time frame in 2019 (2019 group). Included are all patients who attended the ED at Raigmore Hospital during this period from both the local area and tertiary referral from throughout the UK Highlands. Data was collected and analyzed through the ED Information System (EDIS) as well as ward and theatre records. Results A total of 1,978 patients presented to the ED during the lockdown period, compared to 4,777 patients in the same timeframe in 2019; a reduction of 58.6%. Orthopaedic presentations in 2020 and 2019 were 736 (37.2%) and 1,729 (36.2%) respectively, representing a 57.4% reduction. During the lockdown, 43.6% of operations were major procedures (n = 48) and 56.4% were minor procedures (n = 62), representing a significant proportional shift. Conclusion During the COVID- 19 lockdown period there was a significant reduction in ED attendances and orthopaedic presentations compared to 2019. We also observed that there was a proportional increase in fractures in elderly patients and in minor injuries requiring surgery. These represented the majority of the orthopaedic workload during the lockdown period of 2020. Given this shift towards smaller surgical procedures, we suggest that access to a minor operating theatre in or close to ED would be desirable in the event of a second wave or future crisis.

Impact of COVID-19 on acute trauma and orthopaedic referrals and surgery in the UK during the first wave of the pandemic: a multicentre observational study from the COVid Emergency-Related Trauma and orthopaedics (COVERT) Collaborative

“…The 34% reduction in acute trauma referrals is in keeping with previous single-centre studies performed in the UK with results ranging between 26% and 59% 10–13 15 16. As described in these previous studies, we would attribute the overall reduction of trauma workload to be due to reduction in travel and outdoor activities during the national lockdown.…”

“…The lockdown to limit the spread of the virus has had an unforeseen effect in significantly reducing the acute trauma workload described in several singlecentre studies. [10][11][12][13] There has, however, not been a British multicentre reflection of the impact of the COVID-19 pandemic on the orthopaedic workload and its potential impact on patient mortality.…”

“…In response to the NHS emergency declaration,7 the Royal Colleges of Surgeons8 and the British Orthopaedic Association9 both issued statements and guidelines for delivering emergency trauma and orthopaedic care during the COVID-19 outbreak. The lockdown to limit the spread of the virus has had an unforeseen effect in significantly reducing the acute trauma workload described in several single-centre studies 10–13. There has, however, not been a British multicentre reflection of the impact of the COVID-19 pandemic on the orthopaedic workload and its potential impact on patient mortality.…”

The Impact of COVID-19 Restrictions and Changes in Guidelines on Adult Wrist Fracture Management

“…This increase in fractures of elderly patients was also seen at a hospital in Inverness, Scotland. 19…”

Perspective Chapter: Impact of the COVID-19 Pandemic on the Field of Orthopedics

“…A study in the UK focused on orthopedic emergencies, during lockdown, showed that patient visits had a decrease of 58.6%. The orthopedic presentations in 2020 and 2019 were 736 (37.2%) and 1729 (36.2%), a decrease of 57.4% [11]. An orthopedic team in the UK set up a 7-day "One-Stop" clinic for minor injuries/ ambulatory patients.…”