The Relationship of the COVID-۱۹ pandemic with the Incidence and Management of Upper Limb Fractures: Double-Centre Study

Background: The COVID-۱۹ pandemic brought about the placement of severe social restrictions in the UnitedKingdom, limiting activity and impacting public behavior. Limited studies have been published on the relationship ofthe coronavirus pandemic with the presentation and management of upper limb fractures. The aims of this studywere first to assess the change in the incidence of upper limb fractures at key points during the COVID-۱۹ pandemicsuch as the enactment and lifting of lockdowns, and second to evaluate the relationship between local COVID-۱۹burden and measures of service efficiency across our trust.Methods: We undertook a retrospective analysis of all upper limb fracture referrals, admissions, and surgical proceduresfrom the ۱st of March ۲۰۲۰ to the ۲۸th of February ۲۰۲۱. Changes in upper limb fracture incidence were mapped tosignificant changes in social restrictions. Measurements of service efficiency including time from admission to theatreand length of stay for admitted upper limb fracture patients were mapped to local COVID-۱۹ burden. Subgroup analysiswas undertaken to compare across age groups, including the pediatric population, all adults, and the elderly.Results: The study involved ۱۲۵۱, ۶۵۹, and ۶۴۱ patients with upper limb fracture referrals, admissions, and proceduresacross the trust, respectively. Referrals (n=۱۲۸) and procedures (n=۷۲) both peaked in August ۲۰۲۰. Admissions peakedin both May and December ۲۰۲۰ (۶۳ for both). Admissions and procedures both demonstrated a decrease in March andApril ۲۰۲۰ compared to the rest of the study period (۴۰ and ۳۸ admissions, as well as ۴۸ and ۲۹ procedures respectively).Across the cohort, referrals and admissions did not demonstrate a statistically significant relationship with the relaxing ofsocial restrictions (P=۰.۵۰۴). There were statistically significant differences among referrals, admissions, and procedureswhen stratifying patients by age (P=<۰.۰۰۱). Length of stay demonstrated an inverse relationship with COVID-۱۹ burdenthroughout the study period, with the shortest average length of stay recorded in months with the highest number of localCOVID-۱۹ cases. The average time from injury occurrence to theatre increased during the winter months (P=۰.۰۰۱).Conclusion: There is a relationship between changes in social restrictions and the incidence of upper limb fractures.These changes also had differing impacts on upper limb fracture rates when stratifying by patient age groups. Theorthopedic service demonstrated adaptability in response to the local COVID-۱۹ burden, and further research isneeded to determine what effect this had on clinical outcomes.Level of evidence: IV

Keywords:

COVID-۱۹ , Coronavirus , Upper limb trauma