Patient care modifications and hospital regulations during the COVID-19 crisis created inequality and functional hazard for patients with orthopaedic trauma.

ABSTRACT

PURPOSE: The COVID pandemic has decreased orthopaedic fracture operative intervention and follow-up and increased the use of virtual telemedicine clinics. We assessed the implications of this management on future orthopaedic practice. We also surveyed patient satisfaction of our virtual fracture follow-up clinics. METHOD: We prospectively analysed 154 patients during two weeks of 'lockdown' assessing their management. We surveyed 100 virtual fracture clinic follow-up patients for satisfaction, time off work and travel. RESULTS: Forty-nine percent of patients had decisions affected by COVID. Twelve percent of patients were discharged at diagnosis having potentially unstable fractures. These were all upper limb fractures which may go onto mal-union. Twenty-nine percent of patients were discharged who would have normally had clinal or radiological follow-up. No patients had any long-term union follow-up. Virtual telemedicine clinics have been incredibly successful. The average satisfaction was 4.8/5. In only 6% of cases, the clinician felt a further face-to-face evaluation was required. Eighty-nine percent of patients would have chosen virtual follow-up under normal conditions. CONCLUSION: Lessons for the future include potentially large numbers of upper limb mal-unions which may be symptomatic. The non-union rate is likely to be the same, but these patients are unknown due to lack of late imaging. Telemedicine certainly has a role in future orthopaedic management as it is well tolerated and efficient and provides economic and environmental benefits to both clinicians and patients.