Department of Plastic and Reconstructive Surgery, The Royal London Hospital, Barts Health NHS Trust.
Department of Plastic and Reconstructive Surgery, The Royal London Hospital, Barts Health NHS Trust.
Injury. 2021 Mar;52(3):402-406. doi: 10.1016/j.injury.2020.11.047. Epub 2020 Dec 11.
COVID-19 has created huge pressures on healthcare systems. The ongoing provision of major trauma services during this time has proved challenging. We report our experience of managing open lower limb fractures (oLLFs) during the pandemic in a London major trauma centre (MTC).
This was a prospective study of all open lower limb fractures presenting to our unit over the initial 48 days of UK government lockdown - 24th March till 10th May 2020. Results were compared to the same time period in 2019 retrospectively. Epidemiological data, mechanism, Gustilo-Anderson (G-A) severity grading, time to initial debridement and definitive coverage were analysed.
There was a 64% reduction in emergency department (ED) attendances (25,264 vs 9042). There was an 18% reduction in oLLFs (22 vs 18). Approximately three-quarters of injuries were in males across both cohorts (77% vs 78%) and tended to occur in younger patients (median age, 37 vs 35). Road-traffic-accidents (RTAs) were the most common injury mechanism in both 2019 and lockdown, but a rise in jumpers from height was seen in the latter. A similar pattern of G-A severities were seen, however only 3 injuries during lockdown required major soft tissue reconstruction. There was no significant difference in times taken for initial debridement (p = 0.72786) or definitive wound coverage (p = 0.16152). A greater proportion of independent operating was seen during lockdown between orthopaedics and plastic surgery.
Despite government lockdown measures, oLLFs still placed significant burden on our MTC. Notwithstanding significant staffing alterations and theatre pressures, we have been able to ensure these lower limb emergencies remain a surgical priority and have managed to utilise resources appropriately.
COVID-19 给医疗系统带来了巨大压力。在此期间，持续提供重大创伤服务极具挑战性。我们报告了在伦敦重大创伤中心（MTC）管理开放性下肢骨折（oLLF）的经验。
这是一项针对我们单位在英国政府封锁期间最初 48 天（2020 年 3 月 24 日至 5 月 10 日）内所有开放性下肢骨折的前瞻性研究。结果与 2019 年同期进行了回顾性比较。分析了流行病学数据、机制、Gustilo-Anderson（G-A）严重程度分级、首次清创和确定性覆盖的时间。
急诊部（ED）就诊人数减少了 64%（25264 人 vs 9042 人）。oLLF 减少了 18%（22 人 vs 18 人）。在两个队列中，大约四分之三的受伤者为男性（77% vs 78%），且倾向于年轻患者（中位数年龄，37 岁 vs 35 岁）。2019 年和封锁期间，道路交通伤害（RTA）是最常见的损伤机制，但后者高处跳下受伤人数有所增加。G-A 严重程度也呈现出类似的模式，但在封锁期间只有 3 例需要进行重大软组织重建。首次清创（p=0.72786）或确定性伤口覆盖（p=0.16152）的时间无显著差异。封锁期间，骨科和整形外科之间的独立手术比例增加。
尽管政府实施了封锁措施，oLLF 仍给我们的 MTC 带来了巨大负担。尽管人员配置和手术室压力发生了重大变化，但我们仍能够确保这些下肢急症仍是手术的重点，并能够合理利用资源。
