Department of Trauma and Orthopaedic Surgery, Kings College Hospital NHS Foundation Trust, London, UK.
GKT School of Medical Education, Kings College London, London, UK.
Ann R Coll Surg Engl. 2021 Feb;103(2):114-119. doi: 10.1308/rcsann.2020.7026.
Non-injury-related factors have been extensively studied in major trauma and have been shown to have a significant impact on patient outcomes. Mental illness and associated medication use has been proven to have a negative effect on bone health and fracture healing.
We collated data retrospectively from the records of orthopaedic inpatients in a non-COVID and COVID period. We analysed demographic data, referral and admission numbers, orthopaedic injuries, surgery performed and patient comorbidities, including psychiatric history.
There were 824 orthopaedic referrals and 358 admissions (six/day) in the non-COVID period, with 38/358 (10.6%) admissions having a psychiatric diagnosis and 30/358 (8.4%) also having a fracture. This was compared with 473 referrals and 195 admissions (three/day) in the COVID period, with 73/195 (37.4%) admissions having a documented psychiatric diagnosis and 47/195 (24.1%) having a fracture.
There was a reduction in the number of admissions and referrals during the pandemic, but a simultaneous three-fold rise in admissions with a psychiatric diagnosis. The proportion of patients with both a fracture and a psychiatric diagnosis more than doubled and the number of patients presenting due to a traumatic suicide attempt almost tripled.
While total numbers using the orthopaedic service decreased, the impact of the pandemic and lockdown disproportionately affects those with mental health problems, a group already at higher risk of poorer functional outcomes and non-union. It is imperative that adequate support is in place for patients with vulnerable mental health during these periods, particularly as we look towards a potential 'second wave' of COVID-19.
非创伤相关因素已在重大创伤中得到广泛研究，并已证明对患者预后有重大影响。精神疾病和相关药物的使用已被证明对骨骼健康和骨折愈合有负面影响。
我们从非 COVID 和 COVID 期间骨科住院患者的记录中回顾性地收集数据。我们分析了人口统计学数据、转诊和入院人数、骨科损伤、进行的手术以及患者合并症，包括精神病史。
非 COVID 期间有 824 例骨科转诊和 358 例入院（每天 6 例），其中 38/358（10.6%）入院有精神科诊断，30/358（8.4%）也有骨折。这与 COVID 期间的 473 例转诊和 195 例入院（每天 3 例）进行了比较，其中 73/195（37.4%）入院有记录的精神科诊断，47/195（24.1%）有骨折。
大流行期间入院和转诊人数减少，但同时有精神科诊断的入院人数增加了三倍。同时患有骨折和精神科诊断的患者比例增加了一倍以上，因创伤性自杀企图就诊的患者人数几乎增加了两倍。
虽然使用骨科服务的总人数减少了，但大流行和封锁的影响不成比例地影响到那些有心理健康问题的人，而这些人已经处于功能结果较差和非愈合的更高风险中。在这些时期，为有脆弱心理健康的患者提供足够的支持至关重要，特别是因为我们正在为 COVID-19 的潜在“第二波”做准备。
