The impact of COVID-19 on Foot and Ankle Surgery in a Major Trauma Centre

Abstract Aim Non-injury related factors have been extensively studied in major trauma and shown to have a significant impact on patient outcomes, with mental illness and associated medication use proven to have a negative effect on bone health and fracture healing. We report the epidemiological effect of COVID-19 pandemic on mental health associated Orthopaedic trauma, fractures, and admissions to our centre. Method We collated data retrospectively from the electronic records of Orthopaedic inpatients in an 8-week non-COVID and COVID period analysing demographic data, referral and admission numbers, orthopaedic injuries, surgery performed and patient co-morbidities including psychiatric history. Results here were 824 Orthopaedic referrals and 358 admissions (6/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 to 473 referrals and 195 admissions (3/day) in the COVID period with 73/195 (37.4%) admissions having a documented psychiatric diagnosis and 47/195 (24.1%) a fracture. 22/38 (57.9%) and 52/73 (71.2%) patients were known to mental health services, respectively. Conclusions Whilst total numbers utilising the Orthopaedic service decreased, the impact of the pandemic and lockdown disproportionately affected those with mental health problems, a group already at higher risk of poorer functional outcomes and non-union. 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. It is imperative that adequate support is in place for vulnerable mental health patients, particularly as we are currently experiencing the “second wave” of COVID-19.

Download Full-text

Management of multiple rib fractures-results from a Major Trauma Centre with review of the existing literature

10.21203/rs.3.rs-118238/v2 ◽

2020 ◽

Author(s):

Debkumar Chowdhury ◽

P. Okoh ◽

H. Dambappa

Keyword(s):

Major Trauma ◽

Significant Proportion ◽

Fragility Fractures ◽

Trauma Centre ◽

Rib Fractures ◽

Rib Fracture ◽

Analgesic Requirement ◽

Multiple Rib Fractures ◽

Major Trauma Centre ◽

The Impact

Abstract Introduction Rib fractures are amongst the most common fractures following major trauma presenting to the Emergency Department. It accounts for more than 15% of ED presentations (1) on a global scale. As the population ages the incidence of rib fractures also rises often following falls from a relatively small height being part of fragility fractures. The impact of rib fractures is even more significant in the patient with underlying chronic respiratory conditions.Aim To assess our current management of rib fractures at our trauma centreMethod We collected our data from the TARN Registry primarily focussing on patients with multiple rib fractures. The main components were the analgesic requirement of our patients. We also studied the number of rib fracture stabilisation procedures and the average number of ribs fixed.Results The data was collected retrospectively over a period of 12 months. There were 313 patients identified as having chest wall injuries. From the data, 41.9% (131) of patients were over the age of 65 years. A significant proportion of our patients 34.5% (108) were noted to have multiple rib fractures (>3 Ribs). It was noted that 3% (9) of the 313 patients required operations. The average of the patients included in the study was noted to be 61 years with an age range of 17-92 years.Conclusion The mainstay management of rib fracture is provision of adequate analgesia and the prevention of respiratory complications that can all stem from poor ventilatory function amongst other patient factors and injury patterns. Through the decades, surgical stabilisation has gained pace and has found its niche in the management of rib fractures.

Download Full-text

The impact of trauma centre designation on open tibial fracture management

Annals of The Royal College of Surgeons of England ◽

10.1308/003588413x13511609957416 ◽

2013 ◽

Vol 95 (3) ◽

pp. 184-187 ◽

Cited By ~ 10

Author(s):

J Stammers ◽

D Williams ◽

J Hunter ◽

M Vesely ◽

D Nielsen

Keyword(s):

Major Trauma ◽

Average Length ◽

Trauma Centre ◽

Tibial Fractures ◽

Open Tibial Fractures ◽

Major Trauma Centre ◽

Fracture Management ◽

Before And After ◽

Trauma Networks ◽

The Impact

Introduction The British Orthopaedic Association/British Association of Plastic, Reconstructive and Aesthetic Surgeons guidelines for the management of open tibial fractures recommend early senior combined orthopaedic and plastic surgical input with appropriate facilities to manage a high caseload. The aim of this study was to assess whether becoming a major trauma centre has affected the management of patients with open tibial fractures. Methods Data were obtained prospectively on consecutive open tibial fractures during two eight-month periods: before and after becoming a trauma centre. Results Overall, 29 open tibial fractures were admitted after designation as a major trauma centre compared with 15 previously. Of the 29 patients, 21 came directly or as transfers from another accident and emergency deparment (previously 8 of 15). The time to transfer patients admitted initially to local orthopaedic departments has fallen from 205.7 hours to 37.4 hours (p=0.084). Tertiary transferred patients had a longer hospital stay (16.3 vs 14.9 days) and had more operations (3.7 vs 2.6, p=0.08) than direct admissions. As a trauma centre, there were improvements in time to definitive skeletal stabilisation (4.7 vs 2.2 days, p=0.06), skin coverage (8.3 vs 3.7 days, p=0.06), average number of operations (4.2 vs 2.3, p=0.002) and average length of hospital admission (26.6 vs 15.3 days, p=0.05). Conclusions The volume and management of open tibial fractures, independent of fracture grade, has been directly affected by the introduction of a trauma centre enabling early combined senior orthopaedic and plastic surgical input. Our data strongly support the benefits of trauma centres and the continuing development of trauma networks in the management of open tibial fractures.

Download Full-text

Implementing an integrated approach to self-management support in an acute major trauma therapy team: an improvement project

BMJ Open Quality ◽

10.1136/bmjoq-2018-000415 ◽

2019 ◽

Vol 8 (3) ◽

pp. e000415 ◽

Cited By ~ 1

Author(s):

Lucinda Hollinshead ◽

Fiona Jones ◽

Lucy Silvester ◽

Paul Marshall-Taylor

Keyword(s):

Educational Intervention ◽

Major Trauma ◽

Integrated Approach ◽

Trauma Centre ◽

Self Management ◽

Management Support ◽

Allied Health Professionals ◽

Improvement Project ◽

Major Trauma Centre ◽

The Impact

More patients now survive multiple trauma injuries, but the level of long-term unmet needs is high. Evidence shows self-management support can improve patients ’ confidence to manage these needs but traditionally this support starts post-hospital. Starting self-management support early could prepare patients and families for successful transitions from hospital. The skills and commitment of clinicians have been shown to contribute to the success or failure of self-management approaches. The aim of this project was to explore the feasibility of integrating self-management support in an acute major trauma setting by evaluating the impact of an educational intervention on clinicians’ knowledge, attitudes and behaviours regarding self-management support and identifying any barriers and facilitators to integrating self-management into daily practice. Two improvement cycles were carried out over a 1-year period involving 18 allied health professionals (AHPs) in an acute major trauma centre in London, UK. An educational intervention, ‘Bridges Self-Management Programme’ was modified for the setting. The impact was evaluated using (1) a clinician questionnaire to evaluate knowledge and attitudes; (2) case reflection forms and (3) peer review to observe interactions to integrate self-management support. Questionnaire data were summarised and pre-training and post-training scores compared; the qualitative data from written case reflections, verbal and written feedback from training and group discussions was described and analysed thematically. The result of two improvement cycles has shown it was feasible to improve AHP’s knowledge, attitudes and change behaviours regarding self-management support in the acute trauma setting, but difficult to sustain change beyond 6 months. Key barriers such as the pressure to discharge patients and support within the wider multidisciplinary team (MDT) were identified. Facilitators included the introduction of a new key-worker, to enable shared team approaches and paperwork to involve patients and families in goal setting and treatment planning. The main learning was to ensure sustainability mechanisms from the outset, engage the wider MDT in training, and integrate self-management language and principles into team processes.

Download Full-text

The effects of a UK lockdown on orthopaedic trauma admissions and surgical cases

Bone & Joint Open ◽

10.1302/2633-1462.15.bjo-2020-0028.r1 ◽

2020 ◽

Vol 1 (5) ◽

pp. 137-143 ◽

Cited By ~ 13

Author(s):

Matthew Hampton ◽

Matthew Clark ◽

Ian Baxter ◽

Richard Stevens ◽

Elinor Flatt ◽

...

Keyword(s):

Major Trauma ◽

Fragility Fractures ◽

Trauma Centre ◽

Hand Injuries ◽

Orthopaedic Trauma ◽

Nerve Injuries ◽

Number Of Patients ◽

Major Trauma Centre ◽

The Uk ◽

The Impact

Aims The current global pandemic due to COVID-19 is generating significant burden on the health service in the UK. On 23 March 2020, the UK government issued requirements for a national lockdown. The aim of this multicentre study is to gain a greater understanding of the impact lockdown has had on the rates, mechanisms and types of injuries together with their management across a regional trauma service. Methods Data was collected from an adult major trauma centre, paediatric major trauma centre, district general hospital, and a regional hand trauma unit. Data collection included patient demographics, injury mechanism, injury type and treatment required. Time periods studied corresponded with the two weeks leading up to lockdown in the UK, two weeks during lockdown, and the same two-week period in 2019. Results There was a 55.7% (12,935 vs 5,733) reduction in total accident and emergency (A&E) attendances with a 53.7% (354 vs 164) reduction in trauma admissions during lockdown compared to 2019. The number of patients with fragility fractures requiring admission remained constant (32 patients in 2019 vs 31 patients during lockdown; p > 0.05). Road traffic collisions (57.1%, n = 8) were the commonest cause of major trauma admissions during lockdown. There was a significant increase in DIY related-hand injuries (26% (n = 13)) lockdown vs 8% (n = 11 in 2019, p = 0.006) during lockdown, which resulted in an increase in nerve injuries (12% (n = 6 in lockdown) vs 2.5% (n = 3 in 2019, p = 0.015) and hand infections (24% (n = 12) in lockdown vs 6.2% (n = 8) in 2019, p = 0.002). Conclusion The national lockdown has dramatically reduced orthopaedic trauma admissions. The incidence of fragility fractures requiring surgery has not changed. Appropriate provision in theatres should remain in place to ensure these patients can be managed as a surgical priority. DIY-related hand injuries have increased which has led to an increased in nerve injuries requiring intervention.

Download Full-text

The impact of major trauma centre implementation on the pathways and outcome of traumatic intracranial extradural haematoma in a regional centre

British Journal of Neurosurgery ◽

10.1080/02688697.2016.1187252 ◽

2016 ◽

Vol 30 (5) ◽

pp. 541-544

Author(s):

Richard D. C. Moon ◽

Mutwakil A. H. Abdulla ◽

Angelos G. Kolias ◽

Krunal Patel ◽

Ramez W. Kirollos ◽

...

Keyword(s):

Major Trauma ◽

Trauma Centre ◽

Extradural Haematoma ◽

Regional Centre ◽

Major Trauma Centre ◽

The Impact

Download Full-text

The impact of adult major trauma centre status on paediatric trauma activity

Emergency Medicine Journal ◽

10.1136/emermed-2012-201125 ◽

2012 ◽

Vol 30 (10) ◽

pp. 828-830 ◽

Cited By ~ 3

Author(s):

Edward Hannon ◽

Stuart Potter ◽

Thiagarajan Jaiganesh ◽

Zahid Muhktar ◽

Bruce Okoye

Keyword(s):

Major Trauma ◽

Trauma Centre ◽

Paediatric Trauma ◽

Major Trauma Centre ◽

The Impact

Download Full-text

The impact of major trauma centre designation on routine orthopaedic trauma care

Trauma ◽

10.1177/1460408621990555 ◽

2021 ◽

pp. 146040862199055

Author(s):

James Archer ◽

Abdulrahman Odeh ◽

Danielle Piper ◽

Ellen Moore ◽

Annisa Butt ◽

...

Keyword(s):

Hip Fracture ◽

Trauma Care ◽

Major Trauma ◽

Trauma Centre ◽

Current Evidence ◽

Wait Times ◽

Hip Fracture Surgery ◽

Major Trauma Centre ◽

The Impact ◽

Fracture Surgery

Introduction Major Trauma networks were introduced in 2012 to improve care for patients with major traumatic injuries. Current evidence suggests that this has been successfully achieved, however, there are implications for ‘routine trauma care’ of patients who attend a major trauma centre. Methods We assessed time from injury to surgery in August to October in 2011 and 2019. We also assessed the National Hip Fracture Database outcomes for time to surgery for hip fracture patients. Results Average wait times for ankle surgery increased from 4.9 days (18 patients) in 2011 to 7.0 in days (26 patients) in 2019, whilst for distal radius fracture surgery increased from 3.9 days (36 patients) to 6.5 days (23 patients); the percentage of patients who received their hip fracture surgery within the recommended 36 hours was 53.7% in 2011 (322 patients) compared to 66.7% in 2019 (375 patients). Conclusion The wait times for ‘routine trauma care’ have increased since the introduction of the major trauma network. This is probably due to the large demand on major trauma centres presented by complex trauma patients. However, the number of patients undergoing hip fracture surgery within 36 hours has improved, probably driven by the NHS tariff for hip fracture care. Changes to the current major trauma system or an increase in resources are required to help reverse this trend.

Download Full-text