Tse Cheuk Yin, Lee Lawrence Hin Hai, Akbari Amir Reza, Niazi Noman Shakeel, Pillai Anand
Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.
Department of Trauma and Orthopaedics, Manchester University NHS Foundation Trust, M23 9LT Wythenshawe Hospital, Manchester, United Kingdom.
J Wrist Surg. 2021 Oct 31;11(4):322-329. doi: 10.1055/s-0041-1736608. eCollection 2022 Aug.
The coronavirus disease 2019 (COVID-19) pandemic had an unprecedented impact on the healthcare service of the United Kingdom. This study aims to evaluate the effect on wrist fracture care as a result of the COVID-19 pandemic, changes in British Orthopaedic Association Standards of Trauma and Orthopaedics wrist fracture management guidelines, and introduction of lockdown restrictions. This is a retrospective observational study with data collected using the Pathpoint eTrauma platform (Open Medical, United Kingdom). All adults (18 years + ) admitted with wrist fractures within the study phases to Manchester University National Health Service Foundation Trust were included. Each phase of the study period represents a change in lockdown restrictions, including lockdown 1, period of eased restrictions after lockdown 1, lockdown 2, and lockdown 3. These phases were then compared with a prepandemic period. A total of 608 referrals were included for analysis. The number of referrals per week decreased from 9.94 prepandemic to as low as 8.12 during lockdown 2. Falls remained the most common mechanism of injury, followed by cycling that saw an increase by more than threefold from 2.42% prepandemic to 8.17% ( = 0.500) during lockdown 1 and 8.77% ( = 0.0164) during the easing of lockdown 1. Sports-related injuries and occupational injuries decreased throughout. Assaults and altercations, road traffic accidents, roller-skate, and skateboard-related injuries increased throughout. Surgical procedures per week decreased from 5.06 prepandemic to as low as 4.55 during lockdown 1. Procedure cancellations remained steady apart from an increase during lockdown 2. Referrals managed operatively increased from 50.9% prepandemic to 58.9% in lockdown 2, before dropping to 49.2% in lockdown 3. Mean time from presentation to surgery increased from 9.08 days prepandemic to 16.27 days in lockdown 1 but decreased to just below the prepandemic baseline thereafter. Overall, there was a decrease in the number of wrist fracture referrals and surgical procedures compared with before the pandemic. There was also an increased wait-time to surgery and an increased rate of cancellations. Statistical analyses fail to find significance in changes other than mechanisms of injury, which resulted from lockdown restrictions. Therefore, service provision, delivery, and efficiency not affected significantly by changes in guidelines and lockdown restrictions.
2019年冠状病毒病（COVID-19）大流行对英国的医疗服务产生了前所未有的影响。本研究旨在评估COVID-19大流行、英国骨科协会创伤与骨科腕部骨折管理指南的变化以及封锁限制措施的实施对腕部骨折护理的影响。 这是一项回顾性观察研究，使用Pathpoint电子创伤平台（英国Open Medical公司）收集数据。纳入了研究阶段内在曼彻斯特大学国民保健服务基金会信托医院因腕部骨折入院的所有成年人（18岁及以上）。研究期间的每个阶段代表封锁限制措施的变化，包括第一次封锁、第一次封锁后的限制放宽期、第二次封锁和第三次封锁。然后将这些阶段与大流行前时期进行比较。总共纳入608例转诊病例进行分析。 每周转诊病例数从大流行前的9.94例降至第二次封锁期间的低至8.12例。跌倒仍然是最常见的受伤机制，其次是骑自行车，在第一次封锁期间从大流行前的2.42%增加了三倍多，达到8.17%（P = 0.500），在第一次封锁放宽期达到8.77%（P = 0.0164）。与运动相关的损伤和职业损伤总体呈下降趋势。袭击和争吵、道路交通事故、轮滑和滑板相关损伤总体呈上升趋势。每周手术例数从大流行前的5.06例降至第一次封锁期间的低至4.55例。除第二次封锁期间有所增加外，手术取消率保持稳定。手术治疗的转诊病例从大流行前的50.9%增至第二次封锁期间的58.9%，然后在第三次封锁期间降至49.2%。从就诊到手术的平均时间从大流行前的9.08天增至第一次封锁期间的16.27天，但此后降至略低于大流行前基线水平。 总体而言，与大流行前相比，腕部骨折转诊病例数和手术例数有所减少。手术等待时间也有所增加，取消率上升。统计分析未发现除因封锁限制导致的损伤机制变化外的其他变化具有显著性。因此，指南和封锁限制措施的变化未对服务提供、交付和效率产生显著影响。
