Occupational-Seasonal Spine and Other Orthopaedic Injuries due to Fall from Java Plum Tree

Background: Falling from a Java Plum (Jamun) tree is one of the primary causes of Spine and other extremity fractures during the Monsoon season (when it is harvested) in Pakistan. Objective: To assess the distribution of patients with different facture types presented with the history of fall from Jamun tree during Monsoon season. Study Design: Retrospective study Place and Duration of Study: Department of Orthopaedics & Spine Surgery, Ghurki Trust Teaching Hospital, Lahore 1st May 2020 to 31st August 2020, Methodology: Forty two male patients age ranged from 12-55 years of age were enrolled. Information was obtained from the hospital’s trauma registry, and medical records were retrospectively reviewed for data about the type of fractures, occupational status, pre-hospital immobilization, time of presentation, and the time between fall and management and length of hospital stay were reviewed. Results: The average age of the patient was 34.6 years. Twenty four (57.14%) had spine fractures and 18 (42.8%) suffered other axial and skeletal fractures. Nearly three-fourths needed surgical intervention. In contrast, 26.1 % were managed conservatively. Conclusion: During monsoon season, we received 4.6% of extra patients with different injuries following fall from Jamun tree. In most cases, young men from lower socio-economic status suffer from varying degrees of disability and experience financial problems. Keywords: Fall, Java Plum, Mass awareness, Occupational-seasonal injury, Spine fractures

DESCRIPTIVE STUDY OF POST OPERATIVE INFECTION IN OPEN ORTHOPAEDIC INJURIES

Background: In this study, we studied the pattern of bacterial isolates in all cases of open fractures of extremities that came to our hospital. Methods: This descriptive study was to be conducted on open orthopaedic injuries being admitted to the orthopaedic department, from June 2019 to June 2020 after obtaining institutional ethical committee clearance. Results: Culture analysis showed an increase in growth of Gram-negative bacteria, namely Pseudomonas aeruginosa (26.3%) and Escherichia coli (10.5%) while Gram-positive bacteria were Staphylococcus aureus (52.6%) and Klebsiella pneumoniae (10.5%). Conclusion: Unlike surgery in other orthopedic areas, the predicting factors for infection in fracture patients were found to be significantly influenced by open fracture rather than the underlying disease or anatomical features of the patient. However, only the correlation with simple open fracture has been confirmed. Therefore, further studies on the cause of open fracture and the mechanism of open fracture are necessary to determine the risk of infection. Keywords: Infection, Orthopaedics, Open surgery

Trends in emergency department use by older people during the COVID-19 pandemic

Purpose Reports suggest that many older people deferred seeking healthcare during the COVID-19 pandemic due to fear of contracting COVID-19. The aim of this study was to examine trends of emergency department (ED) use by older people during the first wave of the COVID-19 pandemic compared to previous years. Methods The study site is a 1000-bed university teaching hospital with annual ED new-patient attendance of > 50,000. All ED presentations of patients aged ≥ 70 years from March to August 2020, 2019 and 2018 inclusive (n = 13,989) were reviewed and compared for presenting complaint, Manchester Triage Score, and admission/discharge decision. Results There was a 16% reduction in presentations across the 6 months in 2020 compared to the average of 2018/2019. On average, 4 fewer people aged ≥ 70 years presented to the ED per day in 2020. Much of this was concentrated in March (33% fewer presentations) and April (31% fewer presentations), when the country was in ‘lockdown’, i.e. non-essential journeys were banned. There was a 20% reduction in patients presenting with stroke and cardiac complaints. In the 3 months following easing of restrictions, there was a 25% increase in falls and orthopaedic injuries when compared to 2018/2019. Conclusion This study demonstrates a significant decline in the number of older people presenting to the ED for unscheduled care, including for potentially time-dependent illnesses such as stroke or cardiac complaints. Given the possibility of further lockdowns, it is imperative that we consider enabling strategies to ensure older people access unscheduled care in a timely manner when necessary.

495 A Retrospective Seven-Year Study on The Incidence of Cruise Ship Orthopaedic Injuries and Their Impact on A Major Trauma Centre (MTC)

Introduction Cruises have increased in popularity worldwide. Falls are the most common seafaring accident, a leading cause of morbidity and mortality. The aim of this, the first UK study, was to analyse the incidence of orthopaedic injuries sustained on cruise ships presenting to an MTC over a seven-year period. Method A retrospective analysis of cruise injuries resulting in admission or ongoing follow up by the orthopaedic department was conducted. Demographic details, injuries sustained, management and length of stay were reviewed. Results Over the seven-year period, 204 patients were identified, 29 a year on average. The median age was 74 with 70.6% female patients. Of the 221 injuries, 80.9% were fractures (n = 179); neck of femur fractures predominated (27.7%,). There were 140 admissions with a total of 1250 days in hospital. Linear regression models showed the increasing number of admissions to be statistically significant (p < 0.05), as was the upward trend in the number of lower limb injuries (p < 0.05). Conclusions The majority of injuries occur in elderly females, where fragility fractures are common. It is vital that cruise ships put measures in place to minimise the risk of such accidents occurring; we hope our findings can assist the formulation of such protocols.