Utilising the impact of COVID-19 on trauma throughput to adapt elective care models for more efficient trauma care.

BACKGROUND: Coronavirus disease 2019 (COVID-19) has necessitated adaptations in local trauma services, with implementation of novel methods of practice, strategic adaptations, and shifting of resource management. Many of these may serve the driver for landmark changes to future healthcare provision. AIM: To analyse the impact of COVID-19 on service provision by comparing throughput and productivity metrics with preceding years to identify differences in practice that were successful, cost-effective, and sustainable. METHODS: We quantified orthopaedic trauma care provision at a single University Teaching Hospital over a three consecutive year period, from 1st January 2018 to 31st December 2020. Each year was split into four phases based on the 2020 national COVID-19 pandemic periods. We quantitatively analysed change in rates of inpatient trauma operative case load, sub-specialty variation, theatre throughput, and changes in management strategy. Qualitative analysis was based on multidisciplinary team interviews to highlight changes to care pathways. RESULTS: Of 1704 cases were admitted in 2020, 11.9% and 12.4% fewer than 2019 and 2018, respectively. During phase 1, hip fractures encompassed the majority (48.8%) of trauma throughput, with all other subspecialties seeing a reduction. Mean length of stay was shorter during phase 1 (5.7 d); however, the time in theatre was longer (144.3 min). Both, Charlson (0.90) and Elixhauser (1.55) Comorbidity Indices indicated the most co-morbid admissions during 2020 phase 1. CONCLUSION: COVID-19 has resulted in a paradigm shift in how care is accessed and delivered, with many evolving changes and adaptations likely to leave an impression upon healthcare provision in the future.

Lumbar facet joint injection in treating low back pain: Radiofrequency denervation versus SHAM procedure. Systematic review.

The lumbar facet joints have been implicated as one of the causes of low-back pain syndromes. About 15-40% of patients who presented with chronic low-back pain was attributed to lumbar facet joint pain. The purpose of this study was to analyse whether radiofrequency denervation is better than SHAM procedure in treating chronic low-back pain caused by lumbar zygapophysial joints pathology. From the four identified randomised control trials, there is conflicting evidence at an intermediate 3-6-month stage, however; one study demonstrates statistical significance of radiofrequency denervation at 3 months. Longer-term follow-up is needed to prove the efficacy of radiofrequency denervation technique.

Ten- to twelve-year follow-up of the furlong hydroxyapatite-coated femoral stem and threaded acetabular cup in patients younger than 65 years.

We reviewed 82 patients who had 92 primary Furlong uncemented hydroxyapatite (HA)-coated total hip replacements inserted between 1988 and 1992. All patients had the Furlong HA-coated stem and screw in acetabular cup with a 28-mm alumina oxide ceramic modular head. The mean age at the time of primary total hip arthroplasty was 54 years (range, 31-67 years). At 10 years, we reviewed 64 patients (72 total hip arthroplasties). Eight had died (10 total hip arthroplasties), 3 could not attend for follow-up, 2 were lost to follow-up, and 5 were revised (2 for infection and 3 for acetabular loosening and recurrent dislocation). We conclude that the Furlong HA-coated total hip replacement is a good prosthesis for patients younger than 65 years, with a cumulative survival rate of 94.29% at 10 to 12 years using revision as the end point.

Fractured neck of femur in a child after femoral fracture fixation by intramedullary flexible nails: a case report.

Since the introduction of flexible intramedullary nails, the treatment of femoral shaft fractures in adolescents has been revolutionized and this has become the routine treatment in most units, with minimal complications. We report a rare complication of an ipsilateral fractured neck of femur in a fit and healthy 12-year-old girl 6 months after treatment of a traumatic fractured femoral shaft; this was treated effectively with cannulated screws and the patient was successfully discharged without any further complication.