The effect of the COVID-19 pandemic on mental health associated trauma, admissions and fractures at a London major trauma centre.

INTRODUCTION: Non-injury-related factors have been extensively studied in major trauma and have been shown to have a significant impact on patient outcomes. Mental illness and associated medication use has been proven to have a negative effect on bone health and fracture healing. MATERIALS AND METHODS: We collated data retrospectively from the records of orthopaedic inpatients in a non-COVID and COVID period. We analysed demographic data, referral and admission numbers, orthopaedic injuries, surgery performed and patient comorbidities, including psychiatric history. RESULTS: There were 824 orthopaedic referrals and 358 admissions (six/day) in the non-COVID period, with 38/358 (10.6%) admissions having a psychiatric diagnosis and 30/358 (8.4%) also having a fracture. This was compared with 473 referrals and 195 admissions (three/day) in the COVID period, with 73/195 (37.4%) admissions having a documented psychiatric diagnosis and 47/195 (24.1%) having a fracture. DISCUSSION: There was a reduction in the number of admissions and referrals during the pandemic, but a simultaneous three-fold rise in admissions with a psychiatric diagnosis. The proportion of patients with both a fracture and a psychiatric diagnosis more than doubled and the number of patients presenting due to a traumatic suicide attempt almost tripled. CONCLUSION: While total numbers using the orthopaedic service decreased, the impact of the pandemic and lockdown disproportionately affects those with mental health problems, a group already at higher risk of poorer functional outcomes and non-union. It is imperative that adequate support is in place for patients with vulnerable mental health during these periods, particularly as we look towards a potential 'second wave' of COVID-19.

The laparoscopic technique for bilateral inguinal hernias.

From March 1994 to March 1999 359 laparoscopic hernioplasties have been performed on 295 patients. In 349 cases (97.2%) TAPP (transabdominal preperitoneal), in 10 cases (2.8%) TEP (total extraperitoneal) method was used for the treatment. In 64 cases (21.7%) bilateral hernias were operated using TAPP-method only. There were 15 hidden hernias and 14 recurrences on the contralateral side in this group. The hernial ring was covered with two smaller meshes or one bigger. There were no intraoperative complications. In 21 cases (32.8%) subcutaneous emphysema and in 3 cases (4.6%) sero-haematoma was developed. The emphysemas were solved spontaneously in 2-3 hours after the surgery. One haematoma was needed punction. The patients were discharged from the hospital on the second or third postoperative day. The authors found that the bilateral laparoscopic hernioplasty much more favourable for the patients.