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.

Gavril Ilizarov advocated a fine wire tension of between 900N and 1200N for circular frame construction. Wire tension can be achieved via a tensioning device or ‘Russian tensioning’ (a fixed wire lengthening around a bolt). There is limited information on the latter technique. This study explored the tensions achieved via Russian tensioning and reports the impact of a second wire on construct tension.

A single 160mm stainless-steel ring was constructed, then 1.8mm stainless steel wires were secured using a Russian fixation bolt and Russian tensioned with a 2nd bolt. The angle subtended by tensioning using the 2nd bolt was measured using a goniometer. Angles of 45°, 70° and 90° were repeated in triplicates, with wire tension measured using a calibrated tensiometer. A second, orthogonal wire was added and tensioned to the same angle. Tensions of both wires were remeasured and recorded. Unpaired t-tests were used to compare mean tensions. A value of p<0.05 was considered significant.

Tensioning at all angles was insufficient to achieve the target range of 900–1200N (range 99–110N). A second, orthogonal wire changed frame dynamics such that a 90° angle resulted in both wires achieving adequate tension (mean 1143N, SD 307N). Increases were significant across all tensioning angles (p=<0.002) however only biomechanically relevant for 90°.

Russian tensioning is insufficient with a single wire, however the addition of an orthogonal wire increases tension in both wires, reaching the target range at 90° deflection. Further study using wire tensioners is warranted, and also the impact of non-orthogonal wire constructs.