How a Pandemic Changes Trauma: Epidemiology and Management of Trauma Admissions in the UK during COVID-19 Lockdown.

Introduction: On June 24 in the United Kingdom, there were 277,989 cases of COVID-19 and 39,369 deaths recorded. The government enforced a complete lockdown on March 23 that resulted in cessation of all elective admissions on 24th onward, with only acute trauma cases being admitted to hospital. This study aims to characterize the changes in trauma admissions during the first 5-week lockdown period. The hypothesis states that there would be a significant reduction in overall orthopedic trauma admissions, polytrauma, and high-energy outdoor trauma during this COVID-19 period. Methods: All trauma admissions over nearly a 5-week period from March 23, 2020, to April 26, 2020, were collated as the "COVID cohort" and compared to the "control" group of patients from the same hospitals 1 year before between March 23, 2019, and April 26, 2019. Spinal admissions and pediatrics were excluded from the study as they were managed in other regional units. Results: There was a 56% reduction in trauma admissions during the COVID-19 lockdown (133 vs. 304). A majority of the COVID cohort were admitted with fractures (89 vs. 164, P = 0.017, Chi-square test) from home with low-energy falls. Overall, fewer operations were performed than the year before. However, a greater proportion of admitted patients had a surgical orthopedic intervention rather than admission and nonoperative management. Conclusions: There was a reduction in admissions as well as reductions in high energy and occupational injuries. Elderly patients continued to fall at home or in care, sustaining hip fractures. This vulnerable group requires beds, orthogeriatric management followed by surgical intervention and social care. Orthogeriatric services must be maintained to ensure the best clinical outcomes for this group

From Elective Orthopaedic Centre to a COVID-19 Trauma Unit: Rapid transformation

The medical profession is facing one of its biggest challenges in modern history. Declared as the cause of a global pandemic by the World Health Organisation on 11th March 2020, COVID-19 has now been confirmed in over 3.5 million people worldwide. COVID-19 has undoubtedly had an impact on society as a whole; disrupting day-to-day routine, work, and leisure activities. Within our field of orthopaedics, there has been a complete cessation of elective surgery. Our centre, which normally has an annual turnover of over 12,000 patients, has been remodelled to receive trauma from across the county. In this paper, we discuss the impact COVID-19 has had on our local elective orthopaedic centre, and describe how the service provision of a hospital can be redefined in a matter of days. We can demonstrate how an urgent, yet effective, trauma unit can be established to receive trauma from multiple satellite centres