Increased orthopaedic presentations as a result of COVID-19-related social restrictions in a regional setting, despite local and global trends.

BACKGROUND: The coronavirus (COVID-19) pandemic has affected the utilisation of emergency department (ED) services worldwide. The aim of this study was to assess the impact of COVID-19-related public health measures on orthopaedic presentations to a regional Australian hospital. METHODS: A case-control study was performed at a regional trauma hospital in New South Wales (NSW), Australia. Data was collected prospectively from patients that required orthopaedic review in the period corresponding to a declaration of a global pandemic to the end of the NSW lockdown, and compared with retrospective data from the corresponding period in 2019. The five-year average of orthopaedic presentations to ED during the study period were obtained for comparison. The primary outcomes were overall number of presentations, mechanism and anatomical location of injuries, operative versus non-operative management and disposition. RESULTS: During the study period in 2020, presentations requiring orthopaedic review were significantly more frequent than 2019 (496 vs. 280, p < 0.0001), with more requiring admission in 2020 (p < 0.0001). The absolute number of patients managed operatively was higher (p = 0.0002) and significantly more patients were referred for community follow-up (p < 0.0001). There was a 20% increase of consults in 2020 compared to the average number of referrals during the same period in the previous five years. CONCLUSIONS: Contrary to other published literature, lockdown conditions imposed during the COVID-19 pandemic resulted in a surprising 77% increase in orthopaedic presentations to this regional Australian hospital. These findings can be used to better direct resources, preparation and staff education in the current and for future pandemics.

Safe and rapid implementation of telemedicine fracture clinics: the impact of the COVID-19 pandemic.

BACKGROUND: The coronavirus disease outbreak in December 2019 rapidly spread around the world with profound effects on healthcare systems. In March 2020, all elective surgery and elective outpatient clinics were cancelled in our institution, a regional hospital in Northern New South Wales, Australia. With regard to orthopaedic fracture clinics, a telehealth system was implemented on an emergency basis for patient and staff safety to prevent disease transmission. The aim of our study was to investigate whether rapid implementation of telehealth for orthopaedic fracture clinics resulted in an increase in complications. METHODS: A retrospective cohort study of all patients with orthopaedic fracture clinic appointments at a regional New South Wales hospital between 17 March and 8 May 2020 was undertaken. There were 191 patients, including 390 appointments of which 23.1% were conducted via telehealth, namely by phone call. Complications requiring phone calls to the orthopaedic team, presentations to the emergency department, admission to hospital or return to theatre, were recorded. RESULTS: There was no increase in complications following emergent implementation of telehealth for orthopaedic fracture clinic follow-up in our institution. Patients in the telehealth group were significantly older than those in the clinic group. CONCLUSION: The study demonstrates that application of telehealth fracture clinics in a regional Australian setting can be achieved without increasing complication rates and can be used to formulate a rapid telehealth implementation plan if a similar scenario occurs in the future.