The aim of this study was to identify the effect of COVID-19 lockdown on the rates, types, mechanisms and mortality of musculoskeletal trauma across Scotland.

Data for all musculoskeletal trauma requiring operative treatment was collected prospectively from five orthopaedic units across Scotland during the initial lockdown period (23/03/2020-28/05/2020). This was compared with data for the same timeframe in 2018 and 2019. Data collected included all cases requiring surgery, injury type, mechanism of injury, and inpatient mortality.

1315 patients received operative treatment in 2020 compared to 1791 in 2019 and 1719 in 2018. The numbers of all injury types decreased, but the relative frequency of hip fractures increased(36.3% 2020 vs 30.2% 2019, p<0.0001 & 30.7% 2018, p<0.0001). Significant increases were seen in proportion of DIY-related injuries(3.1% 2020 vs 1.7% 2019, p=0.01 & 1.6% 2018, p<0.01) and injuries caused by falls(65.6% 2020 vs 62.6% 2019, p=0.08 & 61.9% 2018, p=0.05). Significant decreases were seen in proportion of RTCs(2.6% 2020 vs 5.4% 2019, p<0.0001 & 4.2% 2018, p=0.02) and occupational injuries(1.8% 2020 vs 3.0% 2019, p=0.03 & 2.3% 2018, p=0.01). A significant increase in proportion of self-harm injuries was seen(1.7% 2020 vs 1.1% 2019, p=0.19 & 0.5% 2018, p<0.0001). Mortality of trauma patients was significantly higher in 2020 (4.9%), than in 2019 (3.2%, p=0.02) and 2018 (2.6%, p<0.0001).

In conclusion, lockdown has resulted in a marked reduction of musculoskeletal trauma requiring surgery in Scotland. There have been major changes in types and mechanisms of injury, and mortality of trauma patients has risen significantly.

Aims

The UK government declared a national lockdown on 23 March 2020 to reduce transmission of COVID-19. This study aims to identify the effect of lockdown on the rates, types, mechanisms, and mortality of musculoskeletal trauma across Scotland.

Involvement in research forms a mandatory part of Trauma & Orthopaedic specialty training. Evidence of publication is a compulsory criterion for attaining Certificate of Completion of Training (CCT). The publishing behaviour of orthopaedic trainees from all four deaneries in Scotland was examined (East, North, South East and West of Scotland).

A literature search was performed for Scottish orthopaedic trainees achieving CCT between July 2005–July 2010 using Knowledge Network and PubMed databases. Data collected included date of publication, article type, journal, publishing institute, number of authors and position of trainee within authors.

There was no significant difference in mean number of publications/trainee prior to specialty training across the four deaneries (EOS 0.18; NOS 0.18; SES 0.25; WOS 0.73). The number of publications/trainee during training was statistically significantly higher in SES (mean 6.31; mode 9; median 4) compared to WOS (2.23;0;1), NOS (2.18;1;2) and EOS (1.72;1;1). However, there was no correlation between a trainee's number of publications during training and post–CCT. There was no significant difference for mean number of authors/trainee publication during training across the four deaneries (range 3.38–3.63), nor mean position of trainee in list of authors (range 1.37–1.67).

This study highlights important differences and notable similarities in publishing behaviour during orthopaedic training across the Scottish deaneries. It suggests that rates of publication relate to factors during training and that publishing during training is not predictive of future behaviour. This research may be of interest to trainees, training committees and orthopaedic departments in future appointments.

Revision hip surgery is reportedly rising inexorably yet not all units report this phenomenon. The outcome of 1143 consecutive Corin TaperFit primary hip arthroplasties (957 patients) performed between 1995 and 2010 is presented. The implants were cemented under pressurisation and combined the TaperFit stem with Ogee flanged cups.

Data was gathered from local arthroplasty database and case note review of revised joints. 13 hips have been revised (1.1%). Cumulative prosthesis survival is 0.99 +/− 0.0. Two femoral stems were revised (0.2%); one at 6 months for sepsis, one at 14 days after dislodgment during reduction of dislocation. No revisions were undertaken for aseptic loosening of the stem or cup, nor for thigh pain. 32 patients (32 hips) ≥15 year follow up, 13 survive today and none have been revised (0%). Of the 471 with ≥10 year follow up, 38 were aged ≤50 at time of surgery and 1/38 has been revised to date (PLAD for dislocation).

The strong population stability in this region, supported by independent investigation by Scottish Arthroplasty Project, endorses the accuracy of the data quoted. The low incidence of revision in this cohort, and absence of revision for aseptic loosening (mean follow up 8.03 years +/− SD 3.94; range 18 months to 16yrs 2 months), substantially supports the longevity and use of cemented, double-taper, polished, collarless femoral stems in combination with cemented polyethylene cups in primary hip arthroplasty in all patient age groups.