Lessons Learnt from Managing Orthopaedic Trauma During the First Wave of the COVID-19 Pandemic at a UK District General Hospital.

Background: The Coronavirus disease (COVID-19) pandemic has contributed to over 1,000,000 deaths worldwide. Hospitals responded by expanding services to accommodate the forecasted rise in COVID-19-related admissions. We describe the effects these changes had on management of orthopaedic trauma and patient outcomes at a district general hospital in Southern England. Methods: Data were extrapolated retrospectively from two separate 6-week periods in 2019 and 2020 (1st April-13th May) using electronic records of patients referred to the orthopaedic team. Soft tissue injuries were included where a confirmed diagnosis was made with radiological evidence. Patients were excluded if no orthopaedic intervention was required. Data were compared between the two time periods. Results: There were fewer attendances to hospital in 2020 compared with 2019 (178 vs. 328), but time from presentation to surgery significantly increased in 2020 (2.94 days vs. 4.91 days, p = 0.009). There were fewer operative complications in 2020 (36/145 vs. 11/88, p < 0.001). However, ordinal logistic regression analysis found a significantly greater complication severity in 2020 including death (p = 0.039). Complication severity was unrelated to COVID-19 status. Conclusions: Restructuring of orthopaedic services in response to the COVID-19 pandemic has been associated with significant delays to surgery and higher post-operative complication severity. Our results demonstrate the need for fast-track emergency operative orthopaedic services in UK district general hospitals whilst the COVID-19 pandemic continues.

Bilateral hip fractures associated with transient osteoporosis of pregnancy.

A case of transient osteoporosis of pregnancy complicated by bilateral neck of femur fractures is reported. We discuss the condition and review the literature, provide information to aid in the diagnostic dilemma clinicians may face when considering imaging techniques and the potential for foetal harm during radiation exposure. We discuss management strategies in such patients.

Percutaneous plating of the low energy unstable tibial plateau fractures: a new technique.

We discuss the management of two low-energy unstable tibial plateau fractures in this report, and describe our new technique of percutaneous plating to stabilise these fractures. This minimally invasive surgery has the obvious advantages to the traditional open reduction and internal fixation and the non-operative management by plaster immobilisation. Stable fixation can be achieved by small fragment plates used in this technique allowing safe mobilisation. This novel method of internal fixation could be a useful inclusion in the armamentarium for the management of tibial plateau fractures and can be safely practised by an orthopaedic surgeon at a District General Hospital.

Primary haematogenous osteomyelitis of the patella: a rare cause for anterior knee pain in an adult.

Acute osteomyelitis of the patella is a very rare condition, which commonly affects children between the ages of 5-15 years. Primary haematogenous osteomyelitis in an adult usually occurs in patients with associated risk factors like intravenous drug abuse, HIV infection, and trauma. This report discusses a similar condition in a 46 year old women with no associated predisposing risk factors. The rarity of this condition and its atypical presentation should be borne in mind while treating an adult patient with anterior knee pain. Point tenderness over the patella should alert a physician to the possibility of osteomyelitis of the patella. The value of bone scan and computed tomography in the early stages to help diagnose this condition has been stressed. The literature has been reviewed and discussed briefly.