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Morcos Z, Barrett-Lee J, Hindi F, Mahmoud M, Gavrila CL, Roberts DC. Hand Injuries During COVID-19 UK Lockdown: How Did the Pandemic Affect 1-Year Functional Outcomes? Hand (N Y) 2024; 19:503-508. [PMID: 36245234 PMCID: PMC11067835 DOI: 10.1177/15589447221127333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
BACKGROUND The COVID-19 outbreak was declared a pandemic in March 2020, forcing the United Kingdom into a national lockdown. The aim was to evaluate the effect of this lockdown on hand injuries referred through the trauma and orthopedics virtual fracture clinic (VFC) service and their subsequent management given limited resources. This study also aimed to identify complications and evaluate functional outcomes. METHODS Patients referred through VFC at Queen Alexandra Hospital during April and May 2020 with hand injuries were analyzed. Isolated injuries to the carpus and wrist were excluded. Controls were compared over identical time spans prior to lockdown and after the restrictions were eased. Functional outcomes were measured using the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, at 12 months after injury. RESULTS There was a 68% reduction in referrals of hand injuries during lockdown. Lower numbers of sporting injuries were seen, in contrast to an increased rate of falls, crush injuries, and recreational cycling. Despite a higher number of patients being discharged from VFC during lockdown, there were no increased rates of complications from conservatively managed hand fractures. Eighty percent reported low QuickDASH scores with a median of 2.3. Satisfaction was high, with 73% either satisfied or very satisfied with their treatment and outcome. CONCLUSION This study demonstrates that there remains a burden of hand trauma during lockdowns, and therefore, service provision for future lockdowns should consider this. Most patients can be managed conservatively, and a high proportion can be discharged from VFC with low complication rates and high satisfaction.
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Affiliation(s)
- Zeid Morcos
- Portsmouth Hospitals University NHS Trust, UK
| | | | - Fadi Hindi
- Portsmouth Hospitals University NHS Trust, UK
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2
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Lawrence OJ, Shanbhag V. Lessons From the Pandemic for Hand Surgery in Wales. Cureus 2024; 16:e56577. [PMID: 38646319 PMCID: PMC11031184 DOI: 10.7759/cureus.56577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2024] [Indexed: 04/23/2024] Open
Abstract
Aims In March 2020 the World Health Organisation (WHO) declared the COVID-19 virus a global pandemic. The United Kingdom's National Health Service (NHS) was placed under unprecedented pressure and hospitals were forced to adapt their working practices to continue offering world-leading healthcare. This project aims to highlight the lessons learnt within hand surgical departments throughout Wales. Using this knowledge, we can consider how these lessons can be implemented in both emergency and elective hand practice. Methods A qualitative questionnaire was distributed to hand consultants working across Health Boards within Wales during the pandemic. The questionnaire encompasses the impact of the pandemic on usual practices and what local departmental changes have been implemented in response to patient needs. Results Across the Welsh Health Boards, we received 12 of 19 consultant responses achieving a 63% response rate and captured data from five of seven (71%) major health boards. The questionnaire revealed that 100% of respondents changed their routine management of elective cases whilst 83% changed their management of hand trauma. 50% reported the need to issue updated management guidelines to junior doctors. The major highlighted lessons were the importance of a dedicated hand fracture clinic, coupled with a ring-fenced day-surgical unit (offering regional anaesthetic support) to manage trauma and elective patients independently from general trauma. Conclusion This qualitative research demonstrates that the pandemic drove the restructuring of many hand departments enabling us to find new, efficient ways of working. We must take these lessons forward to tackle the ever-growing waiting list, increased patient expectations and increasingly complex workloads.
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Affiliation(s)
- Owen J Lawrence
- Orthopaedics and Trauma, Nevill Hall Hospital, Abergavenny, GBR
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3
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Mukit M, McCandless MG, Davidson JC, Hopper S, Jabbour JI, Davidson SF, Walker M. The Evolution of Hand Injuries at a State's Only Level I Trauma Center: A Look From the 1980s Through the Global Pandemic. Cureus 2024; 16:e54882. [PMID: 38533158 PMCID: PMC10965227 DOI: 10.7759/cureus.54882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND The purpose of this study is to evaluate any changes to hand trauma in the past three decades and through the COVID-19 pandemic. We hypothesized that improved consumer safety regulations, changes in access to care, and the impact of a global pandemic, among other variables, have significantly influenced the mechanisms and treatment of hand injuries between the 1980s, 2010s (pre-COVID-19), and 2020s (post-COVID-19). METHODS A retrospective single-center review was performed at the only level I trauma center in Mississippi, identifying all hand trauma consultations between 2012-2019 and 2020-2021, compared to aggregated data from 1989. RESULTS Car accidents, gunshots, saw injuries, door injuries, and falls increased in 2012-2019 and 2020-2021 compared to 1989, whereas knife injuries, glass injuries, industrial injuries, and burns decreased. Crush injuries, de-gloving injuries, and lacerations with irregular edges were increased in recent cohorts, corresponding with increased amputations and tissue loss. Skin and subcutaneous injuries decreased in modern cohorts, corresponding with a decreased ability for primary skin repair and the need for more flaps. Additionally, while hospitalizations have increased, patients have improved follow-up. CONCLUSIONS The nature of hand trauma has changed significantly over the past three decades. Increased numbers of cars and greater access to firearms might have led to increased rates of high-energy trauma, whereas burn and industrial injuries have decreased, potentially secondary to improved safety efforts. Despite increased overall hand trauma, time to treatment and follow-up have improved. Through this study, we can be more cognizant of the evolution of hand trauma in the modern era. This can allow improved access to care and further refine management to optimize functionality for hand injuries.
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Affiliation(s)
- Muntazim Mukit
- Surgery, University of Mississippi Medical Center, Jackson, USA
| | | | - John C Davidson
- Surgery, University of Mississippi Medical Center, Jackson, USA
| | - Samuel Hopper
- Surgery, University of Mississippi Medical Center, Jackson, USA
| | - Jacob I Jabbour
- Surgery, University of Mississippi Medical Center, Jackson, USA
| | | | - Marc Walker
- Surgery, University of Mississippi Medical Center, Jackson, USA
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4
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Riyat H, Morris H, Gillott E, Chris Bainbridge L, Johnson N. The incidence and severity of diabetic hand infection presentations during the COVID-19 pandemic. J Hand Surg Eur Vol 2024; 49:91-96. [PMID: 37656972 DOI: 10.1177/17531934231196026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/03/2023]
Abstract
Level of evidence: IV.
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Affiliation(s)
- Harjoat Riyat
- Sheffield University Teaching Hospitals, Sheffield, UK
| | - Holly Morris
- Pulvertaft Hand Centre, Royal Derby Hospitals, Derby, UK
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5
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Shaw AV, Holmes D, Jansen V, Fowler C, Wormald JCR, Wade RG, Taha R, Reay E, Gardiner MD. RSTN COVID Hand: Hand trauma in the United Kingdom and Europe during the COVID-19 pandemic. J Plast Reconstr Aesthet Surg 2023; 84:258-265. [PMID: 37354711 PMCID: PMC10148718 DOI: 10.1016/j.bjps.2023.04.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 04/25/2023] [Accepted: 04/26/2023] [Indexed: 06/26/2023]
Abstract
The COVID-19 pandemic rapidly impacted the delivery of hand surgery services throughout the UK and Europe; from triage to treatment. Our aim was to assess the impact on management of common hand trauma injuries to inform future service delivery and research. The Reconstructive Surgery Trials Network led a service evaluation during the first wave of COVID-19 in 2020. Data was collected on hand injury management during the COVID-19 pandemic and was compared to the management clinicians would have delivered prior. Across 35 hand surgery units, 2540 patients with hand trauma were included. There was an increase of between 3% and 7% in non-operative management of injuries, apart from flexor tendon injuries where management remained unchanged. Cases triaged by a consultant doubled, with a 22% increase in the see-and-treat model. There was a move to operating in low-resource settings; a 13% increase in the use of minor operating theatres and 10% in clinic rooms. Use of WALANT, absorbable sutures, and remote follow-up also increased by 16%, 24%, and between 11% and 25%, respectively. The reported 30-day complication rate was 3.2%, with a surgical site infection rate of 1.8%. The pandemic led to rapid change in many aspects of hand trauma care. It was the impetus for increased out-of-theatre operating, use of local anaesthetic, and more non-operative management of injuries, without an increase in complication rate. Further research needs to assess the clinical and cost-effectiveness of these changes to ensure that COVID-19 is a catalyst for a modern, evidence-based, and environmentally sustainable delivery of hand trauma services.
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Affiliation(s)
- Abigail V Shaw
- Department of Plastic Surgery, Portsmouth Hospitals University NHS Trust, Cosham, Portsmouth PO6 3LY, UK.
| | - David Holmes
- Department of Orthopaedic Surgery, Leighton Hospital, Mid Cheshire Hospital NHS Foundation Trust, Middlewich Road, Crewe CW1 4QJ, UK
| | - Victoria Jansen
- Pulvertaft Hand Centre, University Hospitals of Derby and Burton NHS Foundation Trust, Uttoxeter Road, Derby DE22 3NE, UK
| | - Christy Fowler
- Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, UK
| | - Justin C R Wormald
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science (NDORMS), University of Oxford, Windmill Road, Oxford OX3 7LD, UK
| | - Ryckie G Wade
- Leeds Institute for Medical Research, University of Leeds, Leeds LS2 9JT, UK
| | - Rowa Taha
- Centre for Evidence Based Hand Surgery, University of Nottingham, Queens Medical Centre Campus, NG7 2UH, UK
| | - Emma Reay
- Department of Hand Surgery, James Cook University Hospital, South Tees NHS Foundation Trust, Marton Road, Middlesborough TS4 3BW, UK
| | - Matthew D Gardiner
- Department of Plastic Surgery, Wexham Park Hospital, Frimley Health NHS Foundation Trust, Wexham Street, Slough SL2 4HL, UK; Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Roosevelt Drive, Oxford OX3 7FY, UK
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6
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Liu IZ, Whitehead J, Schlafly M, Pakhchanian H, Raiker R, Snoddy MC. Quantifying the Impact of COVID-19 on Hand and Wrist Surgery Procedural Volume: A National Analysis of 381,046 Cases. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2023; 5:151-158. [PMID: 36573172 PMCID: PMC9771746 DOI: 10.1016/j.jhsg.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 12/05/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022] Open
Abstract
Purpose To quantify and describe the impact of the COVID-19 pandemic on procedural volume trends in hand and wrist surgery from 2020 to early 2022 at multiple centers. Methods In this retrospective comparative study, a real-time, national, federated research database was used to identify patients of interest from 56 health care organizations across the United States. Patients were queried from March 1, 2018, to February 28, 2022. Current Procedural Terminology codes were chosen using the Accreditation Council for Graduate Medical Education's hand fellowship procedure requirements. Results Common hand and wrist surgeries exhibited substantial fluctuations in procedural volume per health care organization during the COVID-19 pandemic. Time periods with considerable procedural volume decreases corresponded with surges in increased COVID-19 caseloads and emergence of COVID-19 variants. Periods of procedural volume increase occurred in the summer of 2020 and immediately following distribution of the COVID-19 vaccine to the public. Fixation of metacarpal fracture, fixation of phalangeal fracture, tendon transfer, flexor tendon repair, and extensor tendon repair consistently showed decreased volumes over the study period. In contrast, ulnar nerve decompression was the only procedure to experience a statistically significant increase in volume over an entire year (2021, +19.2%, P < .001), as compared to before the pandemic. Conclusions Major milestones of the COVID-19 pandemic correlated with fluctuations in the number of hand and wrist procedures performed across the United States. Future studies should seek to evaluate the impact of patient backlogs and individual procedure fluctuations on financial impacts, patient outcomes, and orthopedic trainee experience. Type of study/level of evidence Economic/Decision Analysis IV.
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Affiliation(s)
- Ivan Z. Liu
- Medical College of Georgia Department of Orthopedics, Augusta University, Augusta, GA
- Corresponding author: Ivan Z. Liu, BA, Medical College of Georgia Department of Orthopedics, Augusta University, 1120 15th St, BA-3300, Augusta, GA 30912.
| | - Jonathon Whitehead
- Medical College of Georgia Department of Orthopedics, Augusta University, Augusta, GA
| | - Madeleine Schlafly
- Medical College of Georgia Department of Orthopedics, Augusta University, Augusta, GA
| | - Haig Pakhchanian
- George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Rahul Raiker
- West Virginia University School of Medicine, Morgantown, WV
| | - Mark C. Snoddy
- Medical College of Georgia Department of Orthopedics, Augusta University, Augusta, GA
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Khatkar H, Kyrdiakides J, McNamara J. The environmental impact of orthopaedic surgery: assessing strategies for change. Br J Hosp Med (Lond) 2022; 83:1-4. [DOI: 10.12968/hmed.2022.0388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Climate change poses one of the most critical threats to humanity. Surgical care needs to be considered in relation to the impending climate emergency. Little thought appears to have been given to the role of operating departments as a high-yield target for environmental change. This article evaluates the environmental impact of orthopaedic surgery, focusing on anaesthesia, waste management and surgical hardware. Developing ‘green’ operating protocols should be the minimum expectation of orthopaedic departments. Just as the management of complex surgical pathology requires a multidisciplinary approach, mitigating the environmental impact of surgical endeavour requires collective action and buy-in.
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Affiliation(s)
- Harman Khatkar
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford Nuffield, Oxford, UK
| | | | - John McNamara
- Department of Trauma and Orthopaedics, Stoke Mandeville Hospital, Aylesbury, UK
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8
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Albright JA, Rebello E, Kosinski LR, Patel DD, Spears JR, Gil JA, Katarincic JA. Characterization of the Epidemiology and Risk Factors for Hand Fractures in Patients Aged 1 to 19 Presenting to United States Emergency Departments: A Retrospective Study of 21,031 Cases. J Pediatr Orthop 2022; 42:335-340. [PMID: 35475776 DOI: 10.1097/bpo.0000000000002164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hand fractures are among the most common injuries presenting in pediatric emergency departments (EDs) with incidence reported as high as 624 hand fractures per 100,000 person-years. If gone untreated, these injuries can lead to pain, loss of function, and psychological trauma. The purpose of this study was to identify risk factors and characterize pediatric hand fractures over a 5-year period. METHODS The National Electronic Injury Surveillance System (NEISS) was queried for all hand fractures in patients aged 1 to 19 years presenting to US EDs between 2016 and 2020. Incidence was calculated using US census data. Cases were retrospectively analyzed using age, location of the injury, sex, coronavirus disease-2019 (COVID-19) era, and etiology of injury. Bivariate logistic regression was used where appropriate. RESULTS A total of 21,031 pediatric hand fractures were identified, representing an estimated 565,833 pediatric hand fractures presenting to EDs between 2016 and 2020. The mean incidence of pediatric hand fractures was 138.3 fractures for 100,000 person-years [95% confidence interval (CI): 136.2-140.4], with a 39.2% decrease in incidence occurring between 2019 and 2020. It was found that 42.2% of the fractures were in patients aged 10 to 14. The incidence of hand fractures for males and females was 97.9 (95% CI: 96.2-99.7) and 40.4 (95% CI: 39.2-41.5), respectively, with the male rate peaking at age 14 and the female rate peaking at age 12. Age, sex, location of the injury, and injury during the COVID-19 pandemic were demonstrated to influence the frequency and etiology of the fracture. CONCLUSION This study determined the incidence of pediatric hand fractures presenting to EDs across the United States. In addition, it identified risk factors for common hand fracture etiologies (sports-related, falling, crush, punching) and demonstrated the change in rates of different etiologies of pediatric hand fractures that presented to US EDs during the COVID-19 pandemic. LEVEL OF EVIDENCE Level III-retrospective comparative study.
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Affiliation(s)
| | | | - Lindsay R Kosinski
- Department of Orthopaedic Surgery, Brown University Warren Alpert Medical School, Providence, RI
| | - Devan D Patel
- Department of Orthopaedic Surgery, Brown University Warren Alpert Medical School, Providence, RI
| | - J Reid Spears
- Department of Orthopaedic Surgery, Brown University Warren Alpert Medical School, Providence, RI
| | - Joseph A Gil
- Department of Orthopaedic Surgery, Brown University Warren Alpert Medical School, Providence, RI
| | - Julia A Katarincic
- Department of Orthopaedic Surgery, Brown University Warren Alpert Medical School, Providence, RI
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9
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Herren DB, Verstreken F, Lluch A, Naqui Z, van der Heijden B. The impact of COVID-19 pandemic on hand surgery: a FESSH perspective. J Hand Surg Eur Vol 2022; 47:562-567. [PMID: 35414270 DOI: 10.1177/17531934221093925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
COVID-19 has affected us all. The following collection of short essays highlights various aspects of the pandemic and how it has impacted hand surgery and lessons learned, from the perspective of the Federation of European Societies for Surgery of the Hand (FESSH) Executive Committee members. A range of topics were individually chosen by each of the five committee members and presented.
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Affiliation(s)
- Daniel B Herren
- Department of Hand Surgery, Schulthess Klinik, Zurich, Switzerland
| | | | - Alex Lluch
- Hand & Wrist Unit, Vall d'Hebron Hospital and Institut Kaplan, Barcelona, Spain
| | - Zaf Naqui
- Department of Trauma, Orthopaedic and Plastic Surgery, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Brigitte van der Heijden
- Radboud University Medical Centre, Nijmegen, The Netherlands.,Jeroen Bosch Hospital's, Hertogenbosch, The Netherlands
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Covino M, Fulchignoni C, Pietramala S, Barbaliscia M, Franceschi F, Maccauro G, Merendi G, Rocchi L. One Year of COVID-19: Lessons Learned in a Hand Trauma Center. J Clin Med 2022; 11:jcm11082163. [PMID: 35456256 PMCID: PMC9024795 DOI: 10.3390/jcm11082163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 04/07/2022] [Accepted: 04/09/2022] [Indexed: 12/04/2022] Open
Abstract
2020 will be remembered worldwide as the year of COVID-19 outbreak. The onset of this pandemic abruptly changed everybody’s life and, in a particular manner, doctors’ lives. Our hand surgery department became rapidly one of the first COVID-19-specialized wards in Italy, impacting considerably the authors’ routines and activities. In this paper, the authors focus on how the demographics of patients with hand trauma changed and how they had to modify their activity. The authors retrospectively took into consideration all patients reaching their emergency department (ED) with hand trauma between 9 March 2020 (the day of the beginning of the first lockdown in Italy) and 8 March 2021 and compared them to those who reached the ED in the three previous years. Authors have analyzed the number of patients, their gender and age, the severity of their trauma, where the trauma occurred, the type of lesion, the percentage of patients who underwent surgery, and the percentage of patients who had an emergency admission. In the last year, the number of patients reaching the ED for a hand trauma has been reduced by two thirds (975 patients during the past year), the mean age of those patients has slightly increased, the severity of cases has increased, places of trauma and type of lesions have changed, and, lastly, the percentage of patients needing surgery who were admitted immediately has increased. This paper shows how the type of patients reaching the ED changed and discusses how surgeons evolved and modified their habits in treating those patients during the first lockdown and the year that followed.
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Affiliation(s)
- Marcello Covino
- Department of Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS—Catholic University of the Sacred Hearth, 00168 Rome, Italy; (M.C.); (F.F.)
| | - Camillo Fulchignoni
- Orthopedics & Hand Surgery Unit, Department of Orthopedics, Fondazione Policlinico Universitario A. Gemelli, IRCCS—Catholic University of the Sacred Hearth, 00168 Rome, Italy; (S.P.); (M.B.); (G.M.); (L.R.)
- Correspondence: ; Tel.: +39-331-788-0630
| | - Silvia Pietramala
- Orthopedics & Hand Surgery Unit, Department of Orthopedics, Fondazione Policlinico Universitario A. Gemelli, IRCCS—Catholic University of the Sacred Hearth, 00168 Rome, Italy; (S.P.); (M.B.); (G.M.); (L.R.)
| | - Marco Barbaliscia
- Orthopedics & Hand Surgery Unit, Department of Orthopedics, Fondazione Policlinico Universitario A. Gemelli, IRCCS—Catholic University of the Sacred Hearth, 00168 Rome, Italy; (S.P.); (M.B.); (G.M.); (L.R.)
| | - Francesco Franceschi
- Department of Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS—Catholic University of the Sacred Hearth, 00168 Rome, Italy; (M.C.); (F.F.)
| | - Giulio Maccauro
- Orthopedics & Traumatology Unit, Department of Orthopedics, Fondazione Policlinico Universitario A. Gemelli, IRCCS—Catholic University of the Sacred Hearth, 00168 Rome, Italy;
| | - Gianfranco Merendi
- Orthopedics & Hand Surgery Unit, Department of Orthopedics, Fondazione Policlinico Universitario A. Gemelli, IRCCS—Catholic University of the Sacred Hearth, 00168 Rome, Italy; (S.P.); (M.B.); (G.M.); (L.R.)
| | - Lorenzo Rocchi
- Orthopedics & Hand Surgery Unit, Department of Orthopedics, Fondazione Policlinico Universitario A. Gemelli, IRCCS—Catholic University of the Sacred Hearth, 00168 Rome, Italy; (S.P.); (M.B.); (G.M.); (L.R.)
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Albright JA, Testa EJ, Hanna J, Shipp M, Lama C, Arcand M. Trends in upper extremity injuries presenting to emergency departments during the COVID-19 pandemic. Am J Emerg Med 2022; 55:20-26. [PMID: 35245777 PMCID: PMC8865962 DOI: 10.1016/j.ajem.2022.02.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 02/11/2022] [Accepted: 02/14/2022] [Indexed: 02/06/2023] Open
Abstract
Introduction Methods Results Conclusion Level of evidence
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12
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Sugand K, Aframian A, Park C, Sarraf KM. 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. BMJ Open 2022; 12:e054919. [PMID: 35042707 PMCID: PMC8771810 DOI: 10.1136/bmjopen-2021-054919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE This is the first British multicentre study observing the impact of the COVID-19 pandemic on orthopaedic trauma with respect to referrals, operative caseload and mortality during its peak. DESIGN A longitudinal, multicentre, retrospective, observational, cohort study was conducted during the peak 6 weeks of the first wave from 17 March 2020 compared with the same period in 2019. SETTING Hospitals from six major urban cities were recruited around the UK, including London. PARTICIPANTS A total of 4840 clinical encounters were initially recorded. 4668 clinical encounters were analysed post-exclusion. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcomes included the number of acute trauma referrals and those undergoing operative intervention, mortality rates and the proportion of patients contracting COVID-19. Secondary outcomes consisted of the mechanism of injury, type of operative intervention and proportion of aerosolising-generating anaesthesia used. RESULTS During the COVID-19 period, there was a 34% reduction in acute orthopaedic trauma referrals compared with 2019 (1792 down to 1183 referrals), and a 29.5% reduction in surgical interventions (993 down to 700 operations). The mortality rate was more than doubled for both risk and odds ratios during the COVID-19 period for all referrals (1.3% vs 3.8%, p=0.0005) and for those undergoing operative intervention (2.2% vs 4.9%, p=0.004). Moreover, mortality due to COVID-19-related complications (vs non-COVID-19 causes) had greater odds by a factor of at least 20 times. For the operative cohort during COVID-19, there was an increase in odds of aerosolising-generating anaesthesia (including those with superimposed regional blocks) by three-quarters, as well as doubled odds of a consultant acting as the primary surgeon. CONCLUSION Although there was a reduction of acute trauma referrals and those undergoing operative intervention, the mortality rate still more than doubled in odds during the peak of the pandemic compared with the same time interval 1 year ago.
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Affiliation(s)
- Kapil Sugand
- MSk Lab, Imperial College London, London, UK
- Department of Trauma and Orthopaedics, Imperial College Healthcare NHS Trust, London, UK
| | - Arash Aframian
- MSk Lab, Imperial College London, London, UK
- Department of Trauma and Orthopaedics, Imperial College Healthcare NHS Trust, London, UK
| | - Chang Park
- Department of Trauma and Orthopaedics, Imperial College Healthcare NHS Trust, London, UK
| | - Khaled M Sarraf
- Department of Trauma and Orthopaedics, Imperial College Healthcare NHS Trust, London, UK
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13
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Changes in acute and trauma hand surgery in the first Covid-19 lockdown in a German trauma center: a retrospective analysis of 338 cases. Arch Orthop Trauma Surg 2022; 142:1289-1299. [PMID: 35179633 PMCID: PMC8854483 DOI: 10.1007/s00402-021-04319-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 12/14/2021] [Indexed: 12/03/2022]
Abstract
INTRODUCTION Although Covid-19 and especially lockdown periods have affected our everyday live, its impact on hand traumatology is under investigated. MATERIALS AND METHODS We retrospectively analyzed all patients presenting at a FESSH accredited HTRC and level 1 trauma center in Germany during the Covid-19 lockdown period and an equivalent timeframe in 2019 regarding incidence of hand trauma, injury mechanism, type of injury and hand surgeries. RESULTS 338 patients presented at our department with acute hand injuries. A significant reduction of work-related accidents was found during lockdown contrary to an increase of do-it-yourself related trauma. Although the incidence of hand trauma decreased during lockdown by 18%, the rate of hand surgery increased in absolute and relative numbers. CONCLUSIONS Although Covid-19 has negatively impacting elective and semi-elective surgeries, acute hand surgery has gained in importance represented by a shift from work related to do-it-yourself trauma and an increased rate of surgical treatment. LEVEL OF EVIDENCE IV (therapeutic).
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14
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Bertelli VTC, Rosifini Alves Rezende LG, Shimaoka FJ, Mandarano Filho LG, Mazzer N, Barbieri CH. Evaluation of the COVID-19 Infection Rate in the Perioperative Period of Elective Surgeries of the Hand and Microsurgery. Hand (N Y) 2021; 18:662-667. [PMID: 34933580 DOI: 10.1177/15589447211064360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND After the beginning of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic (coronavirus disease 2019 [COVID-19]), the world started reducing the number of elective surgeries to reduce the transmission of the coronavirus. Some priority elective surgeries were performed, and there was no increase in contagion rates due to safety protocols and protection measures. The study aims to present the coronavirus infection rate of elective hand surgeries and microsurgery performed during pandemics. METHODS A retrospective study evaluating 188 patients submitted to elective surgical procedures. The exclusion criteria were patients infected by COVID-19 before the surgery and patients who submitted to trauma surgery. Only 108 patients were eligible for this study. The mean age was 47.8 years (range: 15 days-81 years). There were 63 females and 45 males. They were divided into 2 groups: outpatient (n = 49) and inpatient (n = 59) procedures. RESULTS The overall COVID infection rate was 6.48%. The outpatient infection rate was 2.08%, whereas the inpatient infection rate was 10.17% (Student t test: P = .089). The main factor correlated with infection in the postoperative period was the number of postoperative outpatient visits (Student t test: P = .089). No statistical differences were observed between the variables studied, but there was a tendency for patients who submitted to inpatient surgery to get infected by COVID-19 (P = .089). The statistical power was 0.8 (Cohen's d test), showing that large samples are needed to analyze the correlation better. CONCLUSION We concluded that the safety of performing elective hand surgery during the pandemic remains unclear, and more studies with larger samples are needed.
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Risk of surgical site infection in hand trauma, and the impact of the SARS-CoV-2 pandemic: A cohort study. J Plast Reconstr Aesthet Surg 2021; 74:3080-3086. [PMID: 34303636 PMCID: PMC8259108 DOI: 10.1016/j.bjps.2021.06.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 06/27/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND Despite the ubiquity of hand trauma, there remains insufficient published data to reliably inform these patients of surgical site infection (SSI) risk. We describe the risk of SSI in a single-centre cohort of patients with hand trauma, with an analysis of the impact of the coronavirus disease-2019 (COVID-19) pandemic. METHODS Retrospective data collection of consecutive patients who underwent surgery for hand and wrist trauma in a single plastic surgery centre over two, three-month periods. Demographic, injury and operative details, alongside prophylactic antibiotic use, were recorded. Burn injuries and wounds infected at presentation were excluded. Presence of SSI at 30 days (90 days if a surgical implant was used) was assessed. RESULTS Overall, 556 patients - 'Pre-COVID-19' (n = 310) and 'During COVID-19' (n = 246) - were included. Risk of SSI was 3.6% in the aggregated cohort. Female patients were more likely to develop an SSI, even when adjusted for their greater prevalence of bite aetiologies (adj OR 2.5; 95% CI, 1.00-6.37 and p < 0.05). The absolute risk of SSI in the 'Pre-COVID-19' group was 2.3% and 5.3% in the 'During COVID-19' group. The relative risk of developing an SSI in the 'During COVID-19' group was 2.34 (95% CI, 0.95-5.78 and p = 0.06). Baseline characteristics were equivalent between the two groups. CONCLUSION The risk of SSI in hand trauma is the same as the nationally estimated risk for all surgeries; 3-5%. Changes in presentation and practice associated with the first wave of the COVID-19 pandemic did not appear to alter the risk of SSI in patients undergoing surgery for hand trauma.
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Beiter K, Hayden E, Phillippi S, Conrad E, Hunt J. Violent trauma as an indirect impact of the COVID-19 pandemic: A systematic review of hospital reported trauma. Am J Surg 2021; 222:922-932. [PMID: 34148669 PMCID: PMC8129999 DOI: 10.1016/j.amjsurg.2021.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/26/2021] [Accepted: 05/05/2021] [Indexed: 01/04/2023]
Abstract
INTRODUCTION The COVID-19 pandemic has exacerbated many social conditions associated with violence. The objective of this systematic review was to examine trends in hospital reported violent trauma associated with the pandemic. METHODS Databases were searched in using terms "trauma" or "violence" and "COVID-19," yielding 4,473 records (2,194 de-duplicated). Exclusion criteria included non-hospital based studies and studies not reporting on violent trauma. 44 studies were included in the final review. RESULTS Most studies reported no change in violent trauma incidence. Studies predominately assessed trends with violent trauma as a proportion of all trauma. All studies demonstrating an increase in violent trauma were located in the United States. CONCLUSIONS A disproportionate rise in violence has been reported within the US. However, most studies examined violent trauma as a proportion of all trauma; results may reflect relative changes from lockdowns. Future studies should examine rates of violent trauma to provide additional context.
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Affiliation(s)
- Kaylin Beiter
- Louisiana State University Health Sciences Center, United States.
| | - Ellery Hayden
- Louisiana State University Health Sciences Center, United States
| | | | - Erich Conrad
- Louisiana State University Health Sciences Center, United States
| | - John Hunt
- Louisiana State University Health Sciences Center, United States
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Utomo P, Wirawan MY, Kumara HC, Yudistira MB. Changes in Pediatric Fracture Cases during the Coronavirus Disease 2019 Pandemic: Data from a National Referral Orthopedic Hospital in Indonesia. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIM: This study aims to compare the impact of coronavirus disease 2019 (COVID-19) on pediatric fracture services in a national referral orthopedic hospital in Indonesia to understand the service provisions that may be required during the pandemic.
METHODS: The study compared the population group during 1 year of the COVID-19 pandemic in Indonesia to the same period 1 year before. This cross-sectional study was performed in Prof. Dr. R Soeharso Orthopedic Hospital, Surakarta, Indonesia, from March 2019 to February 2021. The subjects were pediatric fracture patients aged 0–18 years. Patients recorded on other orthopedic service support installations such as radiology, laboratory, or physiotherapy and diagnosed with any other orthopedic sub-specialty were excluded.
RESULTS: A total of 1787 patients were recorded in this study, with the mean of pediatric fracture patients during the pre-COVID-19 period was 90.75 (standard deviation [SD]: 28.5) and during the COVID-19 period was 58.16 (SD: 19.17) monthly. In the 1st year of the pandemic, there was a significant reduction in clinical visits compared to the same period in 2019 (p < 0.005).
CONCLUSION: There were significant differences in pediatric fracture cases clinic visits and patients’ length of stay in the COVID-19 period than before the COVID-19 occurred.
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Ferrari A, Sanchis-Gomar F, Mattiuzzi C, Henry BM, Lippi G. Is COVID-19 impacting prostate cancer screening? A survey of prostate-specific antigen test requests during a local outbreak. EJIFCC 2021; 32:69-77. [PMID: 33753976 PMCID: PMC7941059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Although the ongoing pandemic of coronavirus disease 2019 (COVID-19) is directly contributing to negatively affect global health and fitness, the restrictive measures applied for containing the outbreaks are also impacting detection and management of many diseases, including cancers. This study aimed to establish if and how the COVID-19 outbreak may have impacted the practice of routine prostate cancer screening in Verona, Italy. METHODS We searched the laboratory information system of the Service of Laboratory Medicine of the University Hospitals of Verona to identify all test requests for total prostate-specific antigen (PSA) and vitamin D (Vit D; i.e., the locally most requested immunochemical test) for outpatients during the last five years (December 10, 2016, to December 10, 2020). The weekly requests for these tests placed between February 25 and December 9, 2020, were compared to those placed during the same period of previous four years (i.e., 2016-2019). RESULTS The volume of test requests for both Vit D and PSA did not differ in 2020 compared to previous four years. However, a dramatic decline was observed during the local lockdown period (between March 10 and May 17, 2020), with median decrease of 76% for Vit D and 62% for total PSA, respectively. This reduction was compensated by 13% increase for Vit D and 43% increase for total PSA in post-lockdown period. CONCLUSION These results show that the lockdown period established during the first peak of the COVID-19 outbreak in Italy's Verona province was associated with a dramatic decrease in routine prostate cancer screenings.
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Affiliation(s)
- Anna Ferrari
- Service of Laboratory Medicine, University Hospital of Verona, Verona, Italy
| | | | - Camilla Mattiuzzi
- Service of Clinical Governance, Provincial Agency for Social and Sanitary Services, Trento, Italy
| | - Brandon M. Henry
- Cardiac Intensive Care Unit, The Heart Institute, Cincinnati Children’s Hospital Medical Center, Ohio, USA
| | - Giuseppe Lippi
- Service of Laboratory Medicine, University Hospital of Verona, Verona, Italy, Section of Clinical Biochemistry, University of Verona, Verona, Italy,Corresponding author: Prof. Giuseppe Lippi Section of Clinical Biochemistry University Hospital of Verona Piazzale L.A. Scuro, 10 37134 Verona Italy Phone: 0039-045-8122970 Fax: 0039-045-8124308 E-mail:
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Haddad FS. A solid and strong beginning. Bone Jt Open 2020; 1:749-750. [PMID: 33367282 PMCID: PMC7750736 DOI: 10.1302/2633-1462.112.bjo-2020-0180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Fares S. Haddad
- The Bone & Joint Journal, London, UK
- University College London Hospitals NHS Foundation Trust, London, UK
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