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AIMS: The current global pandemic due to COVID-19 is generating significant burden on the health service in the UK. On 23 March 2020, the UK government issued requirements for a national lockdown. The aim of this multicentre study is to gain a greater understanding of the impact lockdown has had on the rates, mechanisms and types of injuries together with their management across a regional trauma service. METHODS: Data was collected from an adult major trauma centre, paediatric major trauma centre, district general hospital, and a regional hand trauma unit. Data collection included patient demographics, injury mechanism, injury type and treatment required. Time periods studied corresponded with the two weeks leading up to lockdown in the UK, two weeks during lockdown, and the same two-week period in 2019. RESULTS: There was a 55.7% (12,935 vs 5,733) reduction in total accident and emergency (A&E) attendances with a 53.7% (354 vs 164) reduction in trauma admissions during lockdown compared to 2019. The number of patients with fragility fractures requiring admission remained constant (32 patients in 2019 vs 31 patients during lockdown; p > 0.05). Road traffic collisions (57.1%, n = 8) were the commonest cause of major trauma admissions during lockdown. There was a significant increase in DIY related-hand injuries (26% (n = 13)) lockdown vs 8% (n = 11 in 2019, p = 0.006) during lockdown, which resulted in an increase in nerve injuries (12% (n = 6 in lockdown) vs 2.5% (n = 3 in 2019, p = 0.015) and hand infections (24% (n = 12) in lockdown vs 6.2% (n = 8) in 2019, p = 0.002). CONCLUSION: The national lockdown has dramatically reduced orthopaedic trauma admissions. The incidence of fragility fractures requiring surgery has not changed. Appropriate provision in theatres should remain in place to ensure these patients can be managed as a surgical priority. DIY-related hand injuries have increased which has led to an increased in nerve injuries requiring intervention.
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AIM: We intend to compare the outcomes of arthroscopic osteoplasty with open neck osteotomy for correction of the hip impingement and improvement of hip function in children with moderate to severe healed Slipped Capital Femoral Epiphysis (SCFE). Our aim is to verify if arthroscopic osteoplasty could achieve the same outcome as open procedures. PATIENTS AND METHODS: A retrospective analysis of the hospital hip database retrieved 187 cases of SCFE from 2006 to 2013. We found 12 patients underwent open neck osteotomy and deformity correction for moderate/ severe healed SCFE and ten underwent arthroscopic osteoplasty of the hip. We compared the outcomes between these groups. RESULTS: In the arthroscopy cohort, the mean age at surgery was 15.8 years (range 13-19 years) and mean follow-up was 46.1 months (range 33-66 months). In the neck osteotomy group, the mean age at surgery was 14.6 years (11-20 years) and mean duration of follow-up was 49 months (36-60 months). The outcomes in arthroscopic osteoplasty group vs. open neck osteotomy were as follows: antero-posterior (AP) slip angle 9.2° (0.3°- 28.8°) vs 10.8° (1°-17.9°) (p = 0.0003), lateral slip angle 44.8° (36.5°-64.2°) vs 13.5° (1°-28.5°) (p = 0.00001), oblique plane deformity 47.1° (40.2°-53.5°) vs 16.7° (1°-28.6°) (p = 0.0003), alpha angle 61.88° (52.1°-123°) vs.34.6° (23.2°-45.6°) (p = 0.0003), anterior offset 0 mm (0 mm-2 mm) vs. 5 mm (2-13 mm) (p = 0.0003), modified Harris hip score (MHHS) 75.5 (58.75-96.8) vs. 90 (86.2-99) (p = 0.003), non-arthroplasty hip score (NAHS) 67.12 (18.75-100) vs. 92.1 (81.25-100) (p = 0.002), internal rotation 20° (0-20°) vs. 50° (30°-70°) (p = 0.0002), respectively. CONCLUSION: Even though the radiographic correction lagged behind in the arthroscopic group, the functional outcomes achieved did convey the gain of function in this cohort. In carefully selected cases, arthroscopy could be a less invasive procedure which has desirable outcomes.