Abstract
BackgroundDue to the current COVID-19 pandemic, there has been an increase in the need for the virtual follow-up of patients. These innovations in clinical care have helped to reduce hospital attendance of patients and the spread of the virus. Injuries such as wrist fractures that are non-obligatory are increasingly being followed up virtually. This paper compares the early experience of management of wrist fractures in a District General Hospital in the United Kingdom during the COVID-19 pandemic lockdown with a similar period before.MethodsA retrospective study of the management and clinical follow-up of all skeletally mature patients seen in the Accident and Emergency (A&E) department with a radiologically confirmed distal radius fracture after imposition of COVID-19 lockdown measures in the United Kingdom (between March 23, 2020 and May 24, 2020), and comparison with a control group of patients with distal radius fractures seen within a similar time frame the previous year (March 23, 2019 to May 24, 2019).ResultsDuring the COVID-19 lockdown, a total of 39 skeletally mature patients (85% females; average age of 70.4 years [SD: 14.6]) who had suffered a wrist fracture were seen. A total of 23% of the patients had surgical fixation. The others were managed conservatively and followed up regularly in the fracture clinic and by virtual telephone consultation in 15% (p > 0.05) compared to the previous year. Three patients who had an AO/OTA Type-C fracture were not keen on surgery, citing the COVID-19 pandemic. Patients had their operations at 5.2 days post-injury on average compared to the pre-COVID average of 6.4 days post-injury.ConclusionThis preliminary study showed that patients considered "high risk" (as per the UK government guidance on shielding and protecting people who are clinically extremely vulnerable from COVID-19) with low functional demands who had suffered fractures of the distal radius were followed up mostly virtually after their first A&E attendance, thereby eliminating unnecessary hospital attendances. There was no difference in the epidemiology of wrist fractures pre- and post-COVID-19 lockdown. No COVID-positive patients were treated.The limitations of this study are the fact that it is cross-sectional with a lack of patient-reported outcome measures (PROM). As this was only a preliminary study to assess initial results, it will be followed up by a full report assessing outcomes at defined intervals.
Highlights
The WHO confirmed a novel strain of COVID-19 was responsible for the outbreak of a respiratory-type illness in Wuhan City, Hubei province of China, and declared this a pandemic on March 12, 2020 [1]
A retrospective study of all skeletally mature patients seen in the A&E department with a radiologically confirmed wrist fracture between the imposition of lockdown measure in the United Kingdom on March 23, 2020 and May 24, 2020, and a control group of patients with the same injury seen in the same period the previous year (March 23, 2019 and May 24, 2019)
The British Orthopaedic Association Audit Standards for Trauma (BOAST) management of distal radial fractures standards published in 2017 recommends consideration of nonoperative management in patients older than 65 years with a dorsally displaced distal radius fracture and with no significant deformity or neurological compromise [15]
Summary
The WHO confirmed a novel strain of COVID-19 was responsible for the outbreak of a respiratory-type illness in Wuhan City, Hubei province of China, and declared this a pandemic on March 12, 2020 [1]. Due to the current COVID-19 pandemic, there has been an increase in the need for the virtual follow-up of patients. These innovations in clinical care have helped to reduce hospital attendance of patients and the spread of the virus. Injuries such as wrist fractures that are non-obligatory are increasingly being followed up virtually. This paper compares the early experience of management of wrist fractures in a District General Hospital in the United Kingdom during the COVID-19 pandemic lockdown with a similar period before
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