The Use of Fluoroscan in Hand Clinic During the Covid Pandemic to Optimise Conservative Treatment

Introduction The study assessed the use of Fluoroscan (Hologic, Inc., Marlborough, MA) in hand clinic as advised by the British Orthopaedic Association (BOA) during the COVID-19 pandemic to facilitate treatment of fractures requiring manipulation and reduce admissions to evaluate if this should be embedded in practice permanently. Method Eighty-three wrist and hand fractures requiring manipulation were identified between April 2020 and March 2021. Demographics, mechanism of injury, timing of intervention, radiological outcome, further intervention and functional assessment by QuickDASH scoring were recorded. Results Sixty-eight cases were manipulated within the first week of fracture, simple pain control measures were used, and dose area product (DAP) averaged 1.3 Gy cm2 well below the dose limit set by the trust. Satisfactory fracture reduction was achieved in 59 cases avoiding admission. Further surgical intervention was offered to 24 patients: five re-manipulated while 19 had operation, all with a good functional outcome. Conclusion Fluoroscan use in fracture clinics achieved effective fracture control in 77% of cases. The use of Fluoroscan avoided admissions for surgery during the pandemic and lengthy clinic visits, four out of five did not need admission.

The Use of Fluoroscan in Hand Clinic During the Covid Pandemic to Optimise Conservative Treatment.

Introduction The study assessed the use of Fluoroscan (Hologic, Inc., Marlborough, MA) in hand clinic as advised by the British Orthopaedic Association (BOA) during the COVID-19 pandemic to facilitate treatment of fractures requiring manipulation and reduce admissions to evaluate if this should be embedded in practice permanently. Method Eighty-three wrist and hand fractures requiring manipulation were identified between April 2020 and March 2021. Demographics, mechanism of injury, timing of intervention, radiological outcome, further intervention and functional assessment by QuickDASH scoring were recorded. Results Sixty-eight cases were manipulated within the first week of fracture, simple pain control measures were used, and dose area product (DAP) averaged 1.3 Gy cm2 well below the dose limit set by the trust. Satisfactory fracture reduction was achieved in 59 cases avoiding admission. Further surgical intervention was offered to 24 patients: five re-manipulated while 19 had operation, all with a good functional outcome. Conclusion Fluoroscan use in fracture clinics achieved effective fracture control in 77% of cases. The use of Fluoroscan avoided admissions for surgery during the pandemic and lengthy clinic visits, four out of five did not need admission.

How Do Orthopaedic Patients Prefer to Be Contacted During a Pandemic?

Introduction Communication with patients is a vital part of the surgical pathway, and when done effectively, it can greatly improve patient outcomes and patient satisfaction and reduce canceled appointments. Different forms of communication work well for different patient demographics, and it is important to optimize communication techniques. We designed a study to review the communication preferences of orthopedic patients during the COVID-19 pandemic. Methods A cross-sectional study was performed by asking patients who were due to undergo orthopedic procedures to answer a questionnaire on their communication preferences, the reminder notice period for appointments, and safety and satisfaction ratings during the COVID-19 pandemic. Results Communication method preferences are influenced by patient factors such as gender and age. Phone calls were the most popular communication method throughout all patient groups, with 61% selecting it as their preference. Younger patients preferred multiple communication methods of phone calls, texts, and emails, whereas the older group had a stronger preference for letters. Letters were more popular among females (28% compared to 10% of males), whereas males had a stronger preference for other communication methods. The majority of patients said they would not have liked a letter prior to their clinic appointment (65%). Of those who indicated a preferred notice period, 73% would have liked five days or less notice prior to their clinic appointment, while 65% would have liked 10-14 days notice prior to their surgery. The average safety rating was 55%. The overall satisfaction rating with the communication process was 71.7%. Conclusion The COVID-19 pandemic has changed patient feelings towards healthcare and, as a result, changed the way healthcare is delivered. Communication method preferences among trauma and orthopedic patients vary and depend on factors such as gender and age. If healthcare departments can optimize their communication processes, they will improve their patient outcomes and enhance their resources.

Musculoskeletal Attendances to a Minor Injury Department During a Pandemic.

INTRODUCTION: As coronavirus disease 2019 (COVID-19) became a public health emergency of international concern, countries across the globe began to instate strict social distancing restrictions or "lockdowns". During these times emergency departments in the United Kingdom (UK) recorded a significant drop in patients attending when compared to the same months of previous years. Attendances related to musculoskeletal (MSK) trauma also saw a significant drop in numbers Objective: The purpose of this retrospective audit was to investigate patterns of injuries attending during the pandemic and more specifically during times of lockdown. METHOD: Retrospective audit data was collected from an electronic medical record system (MediTech V6) during the time period of the first lockdown in the UK. Data was collected for patients attending the emergency department at the Queens Hospital Burton site of the University Hospitals of Derby and Burton National Health Service (NHS) Trust. Presenting complaints were recorded for the entire emergency department, and diagnosis on discharge and activity status was recorded for minor injuries only. This data was then compared to the same date from 2019. RESULTS: Overall attendances in the emergency department decreased by 45.42% during the first lockdown when compared to the same time period in 2019. MSK problems also saw a significant drop as back pain decreased by 58.88%, neck pain fell by 78.52% and limb problems decreased by 59.74%. When comparing data from the minor injury department, limb problems decreased by 20.45%. The number of soft tissue injuries decreased by 24.05% and fractures decreased by 7.96%. CONCLUSION:  Attendances in the emergency department were greatly reduced during the COVID-19 pandemic, especially during the first lockdown. The rates of fractures and soft tissue injuries within the minors' area of the emergency department were also reduced but not at the same rate as the overall attendance. A large number of fractures and soft tissue injuries still presented to the emergency department despite reduced national activity. These attendances may be as a result of the increased rate of Do It Yourself (DIY)-related injuries and altered patient/social behaviour due to lockdown, social distancing, and seasons/weather. Further research would be required to investigate the changing patterns of behaviour especially as we enter a second wave of cases.