The Impact of COVID-19 on Bicycle-Related Injuries Managed at a Level 1 Major Trauma Center in London, United Kingdom.

Introduction The COVID-19 pandemic changed peoples' travel behaviors; an uptake in cycling was observed in the United Kingdom. The aim of this study was to assess the cycling-related orthopedic injuries presented to a major trauma center (MTC) before and during the COVID-19 pandemic. Method This retrospective observational single-center study analyzed referrals to the orthopedic department during a matched two-month period in 2019 and 2020. Data were collated on cycling-related injuries including demographic variables, mechanism of injury, anatomical area of injury, and the management of injury. The data were compared and statistical analysis was performed using the Pearson Chi-squared test to assess for significance. Results A total of 2409 patients were referred to the orthopedic department with injuries. A 35.6% decrease in total referrals was made during the COVID-19 pandemic. Analysis of cycling-specific injuries demonstrated a statistically significant increase in referrals to the orthopedic department during the COVID-19 pandemic. A statistically significant difference in upper limb trauma was also observed during the COVID-19 pandemic. Patterns of management, namely operative vs. non-operative management, did not demonstrate a difference in the two time periods. Discussion This study highlights that during the COVID-19 pandemic, cycling behavior changed with more patients suffering orthopedic injuries as a result. Orthopedic departments may need to plan for this change in behaviors with more capacity being created to manage the demand. Conclusion Cycling-related injuries referred to the orthopedic department increased during the pandemic.

Clinical outcomes and complications of the Zadek calcaneal osteotomy in Insertional Achilles Tendinopathy: A systematic review and meta-analysis.

BACKGROUND: The Zadek osteotomy, a dorsal closing wedge osteotomy of the calcaneus, has been described as a treatment option in patients with Insertional Achilles Tendinopathy (IAT) that have failed conservative management. The aim of this study was to evaluate the clinical outcomes and the complications of the Zadek for the management of IAT. METHODS: PubMed, EMBASE and Cochrane Central Register of Controlled Trails (CENTRAL) were searched for all studies to November 2022. PRISMA guidelines were followed. The overall estimates of effect were presented as Weighted Mean Difference (WMD) and 95 % confidence intervals (CIs). Meta-analysis was conducted using the Review Manager Software (RevMan, Version 5.4). RESULTS: Ten studies with 232 patients were included. Functional scores and pain levels were significantly improved after the Zadek osteotomy (p < 0.00001). There were a total of 22 complications reported in the included studies and they were all considered minor. The most common complications were superficial wound infection and sural nerve paraesthesia. CONCLUSIONS: The Zadek osteotomy is a safe and effective procedure for patients with IAT. There are no well-designed randomized controlled trials in the literature assessing the outcomes of a Zadek osteotomy against alternate surgical treatments and future research should focus on this. LEVEL OF EVIDENCE: II.

Impact of the COVID-19 pandemic on the management of open fractures in a major trauma centre.

INTRODUCTION: The Coronavrius-19 (COVID-19) pandemic has presented the biggest challenge that the National Health Service (NHS) has ever seen. As one of the worst affected regions, Orthopaedic service provision and delivery in London, changed dramatically. Our hypothesis is that these restrictions adversely impacted the care of open fractures in our major trauma unit in London. METHODS: This is a prospective case control study comparing the management of patients presenting pre-COVID, to those presenting during the height of the COVID pandemic in London. The pre-COVID, control cohort presented between the 1st October and the November 30, 2019. The COVID cohort presented between the April 1, 2020 and the May 31, 2020. Data was collected that related to the 11 clinical domains of the British Orthopaedic Association Standards of Trauma (BOAST) 4 guidance, as well as early complications. RESULTS: Of the 11 domains, 100 % compliance was achieved in 6 components, across both groups where applicable. During pre-COVID times, the timing to initial debridement was within 12 h for High energy trauma in 16/28 (57.1 %), dropping to 7/22 (31.8 %) during COVID, (p = 0.004). Definitive soft tissue closure within 72 h If not achievable at initial debridement dropped from 9/10 (90.0%) to 4/6 (66.7 %), (p = 0.006). There was no significant difference in early complication rates. CONCLUSION: Coronavirus has changed the landscape of healthcare worldwide and impacted open fracture care by increasing time to theatre. This had no effect on early complication rate but longer term effects remain to be seen.

Cam type femoro-acetabular impingement: quantifying the diagnosis using three dimensional head-neck ratios.

OBJECTIVE: Cam hips are commonly quantified using the two-dimensional α angle. The accuracy of this measurement may be affected by patient position and the technician's experience. In this paper, we describe a method of measurement that provides a quantitative definition of cam hips based upon three-dimensional computed tomography (CT) images. MATERIALS AND METHODS: CT scans of 47 (24 cam, 23 normal) femurs were segmented. A sphere was fitted to the articulating surface of the femoral head, the radius (r) recorded, and the femoral neck axis obtained. The cross sectional area at four locations spanning the head neck junction (r/4, r/2, 3r/4 and r), perpendicular to the neck axis, was measured. The ratios (Neck/Head) between the areas at each cut relative to the surface area at the head centre were calculated and aggregated. RESULTS: Normal and cam hips were significantly different: the sum of the head-neck ratios (HNRs) of the cam hips were always smaller than normal hips (p < 0.01). A cut off point of 2.55 with no overlap was found between the two groups, with HNRs larger than this being cam hips, and smaller being normal ones. CONCLUSION: Owing to its sensitivity and repeatability, the method could be used to confirm or refute the clinical diagnosis of a cam hip. Furthermore it can be used as a tool to measure the outcome of cam surgery.