Evolving Practice in Management of Pelvic-Acetabular Trauma: COVID-19 Experience From a Tertiary Referral Centre in the UK.

Abstract

IntroductionThe United Kingdom was one of the hardest-hit countries during the COVID-19 Pandemic. The UK government announced three national lockdowns to control the spread of the coronavirus and prevent the NHS from getting overburdened with COVID-19 related attendances. Two of the most significant peaks in terms of COVID-19 related hospitalizations and COVID-19 related deaths were in Summer 2020 (corresponding to lockdown 1, which was in effect from 26th March to 26th May 2020) and early 2021 (corresponding to lockdown 3, which was in effect 6th January to 8th March 2021).During this time, a significant proportion of NHS resources was being diverted towards the treatment of COVID-19 patients. Measures were being taken to prevent unnecessary hospitalizations and reduce patient contact. These included but were not limited to measures to reduce attendances to Emergency departments, introducing telemedicine clinics, and pausing elective services. Our hospital is a Major Trauma Centre providing Tertiary Pelvic trauma service to the Greater Manchester area and the North West of England. We conducted this retrospective comparative study to compare the trends in presentation and Management of Pelvic trauma and identify trends in how these changed throughout the pandemic. We want to share these insights with our readers.MethodologyWe conducted a retrospective comparative study by comparing two cohorts of patients, patients presenting to the Pelvic Trauma service during Lockdown 1 and Lockdown 3 in the UK, named Group A and Group B, respectively. Data on patient demographics, injuries, and their management was identified from the Electronic Patient Record System. The data analysis was carried out with the aid of Stata/IC version 16.1. using descriptive Statistics.ResultsGroup A contained 19 patients, with a mean age of 66.9 years. Group B contained 23 patients with a mean age of 67.4 years. There was no statistically significant difference in these patients' population demographics, injury patterns, and management (operative vs conservative). However, there was an absolute reduction in the complication rate from Group A to Group B of 17.2% (26.3% vs 9.1%). The higher complication rate during Lockdown 1 can be explained by conservatively managing Pelvic and Acetabular Fractures that would have been eligible for fixation, had COVID-19 not been a factor.ConclusionsWithin the limitations of our study, it appears that operatively managing a carefully selected cohort of acute Pelvic Trauma patients with proper precautions was safe and effective. It is unclear whether there was an added benefit to having a higher threshold to operate and adopting the watch-and-wait policy in Lockdown 1. We recommend continuing to follow the current evidence and fix these fractures early.