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Orthopaedic Proceedings
Vol. 103-B, Issue SUPP_8 | Pages 10 - 10
1 May 2021
Hall AJ Clement ND MacLullich AMJ White TO Duckworth AD
Full Access

The aim was to determine the influence of COVID-19 on 30-day mortality in hip fracture. Secondary aims were to examine: (1) predictors of COVID-19 on presentation and later in the admission; (2) rate of hospital-acquired COVID-19; (3) predictive value of negative swabs on admission. A nationwide multicentre retrospective cohort study of all patients with hip fracture in all 17 Scottish hospitals in March-April. Demographics, blood results, COVID-19 status, Nottingham Hip Fracture Score (NHFS), management, length of stay (LOS), and 30-day mortality were recorded. 78/833 (9.4%) patients had COVID-19 (65 swab-proven). 30-day survival with COVID-19 was lower than without (65.4% vs 91%; p<0.001). COVID-19 within 7 days of admission (likely community-acquired) was independently associated with male sex (OR 2.34, p=0.040, CI 1.04–5.25) and COVID-19 symptoms (OR 15.56, CI 6.61–36.60, p<0.001). COVID-19 within 7–30 days (probable hospital-acquired) was independently associated with male sex (OR 1.73, CI 1.05–2.87, p=0.032), NHFS □7 (OR 1.91, CI 1.09–3.34, p=0.024), pulmonary disease (OR 1.68, CI 1.00–2.81, p=0.049), ASA □3 (OR 2.37, CI 1.13–4.97, p=0.022) and LOS □9 days (OR 1.98, CI 1.18–3.31, p=0.009). 38/65 (58.5%) of COVID-19 cases were probably hospital-acquired. The false negative rate of swabs on admission was 0% in asymptomatic and 2.9% in symptomatic patients. COVID-19 was associated with a threefold-increased 30-day mortality. Nosocomial transmission may have accounted for half of all cases. Identification of risk factors for having COVID-19 on admission, or acquiring COVID-19 later, may guide patient pathways. LOS was the only modifiable risk factor, emphasising the importance of high-quality, timely care


Orthopaedic Proceedings
Vol. 103-B, Issue SUPP_8 | Pages 1 - 1
1 May 2021
MacDonald DRW Neilly DW Davies PSE Crome CR Jamal B Gill SL Jariwala AC Stevenson IM Ashcroft GP
Full Access

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


Bone & Joint Open
Vol. 3, Issue 3 | Pages 261 - 267
22 Mar 2022
Abe S Kashii M Shimada T Suzuki K Nishimoto S Nakagawa R Horiki M Yasui Y Namba J Kuriyama K

Aims

Low-energy distal radius fractures (DRFs) are the most common upper arm fractures correlated with bone fragility. Vitamin D deficiency is an important risk factor associated with DRFs. However, the relationship between DRF severity and vitamin D deficiency is not elucidated. Therefore, this study aimed to identify the correlation between DRF severity and serum 25-hydroxyvitamin-D level, which is an indicator of vitamin D deficiency.

Methods

This multicentre retrospective observational study enrolled 122 female patients aged over 45 years with DRFs with extension deformity. DRF severity was assessed by three independent examiners using 3D CT. Moreover, it was categorized based on the AO classification, and the degree of articular and volar cortex comminution was evaluated. Articular comminution was defined as an articular fragment involving three or more fragments, and volar cortex comminution as a fracture in the volar cortex of the distal fragment. Serum 25-hydroxyvitamin-D level, bone metabolic markers, and bone mineral density (BMD) at the lumbar spine, hip, and wrist were evaluated six months after injury. According to DRF severity, serum 25-hydroxyvitamin-D level, parameters correlated with bone metabolism, and BMD was compared.


Bone & Joint Open
Vol. 1, Issue 10 | Pages 639 - 643
12 Oct 2020
Atia F Pocnetz S Selby A Russell P Bainbridge C Johnson N

Aims

The aim of this study was to evaluate the need for hand trauma services during the COVID-19 pandemic lockdown, specifically related to surgical requirements. This will provide useful information for planning and resource allocation in the event of any further lockdown.

Methods

A prospective analsysis of all patients attending our hand trauma unit throughout the UK COVID-19 lockdown period (24 March to 10 May 2020) was carried out. Prospectively collected departmental data from the same period in 2019 was obtained and reviewed for comparison. The number of patients attending clinic, undergoing surgery, the type of surgical procedure, and rate of surgery was compared.


The Bone & Joint Journal
Vol. 98-B, Issue 5 | Pages 654 - 659
1 May 2016
Garala K Taub NA Dias JJ

Aims

This study explores the epidemiology of patients with a fracture of the scaphoid presenting to a regional teaching hospital.

Patients and Methods

All patients with a confirmed fracture of the scaphoid over a retrospective period between January 2010 and May 2013 were included. Their demographics, deprivation status and when the fracture occurred was noted and assessed. There were 415 fractures in 365 males and 50 females.