Management of open fractures of the lower limb during the COVID-19 pandemic: are the standards of treatment being maintained? A study from a major trauma centre in England

Authors

  • Rajan Choudhary Department of Trauma and Orthopaedics, Newcastle Road, Stoke on Trent, United Kingdom
  • Madhumita Gupta Department of Plastic Surgery, Royal Stoke University Hospital, Newcastle Road, Stoke on Trent, United Kingdom http://orcid.org/0000-0003-0837-8860
  • Shahidul Huq Department of Plastic Surgery, Royal Stoke University Hospital, Newcastle Road, Stoke on Trent, United Kingdom
  • Wareth Maamoun Department of Plastic Surgery, Royal Stoke University Hospital, Newcastle Road, Stoke on Trent, United Kingdom

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20213232

Keywords:

Open fracture lower limb, COVID-19, BOAST guidelines

Abstract

Background: Coronavirus disease 2019 (COVID 19) has created an immense strain on the NHS. During the height of the pandemic, trauma services were affected by redeployment, reduced theatre capacity and staff illness, and COVID BOAST guidelines were introduced.

Methods: This retrospective study aimed to evaluate the standards of management of open fractures of the lower limb at a Major Trauma Centre in the United Kingdom during the COVID-19 pandemic and compare the same with the pre-pandemic period. Patient demographics, mechanism of injury, timing and mechanism of initial debridement and definitive soft tissue and skeletal fixation were noted. Outcomes including duration of hospital stay, 30 day and 1 year mortality were also assessed.

Results: There was an overall 21% reduction in admissions with open lower limb fractures during the pandemic period with a 48% reduction during the first lockdown. There was a significant reduction in time taken from Emergency Department presentation to first debridement as well as a notable increase in operating outside of regular theatre hours. There was little difference in operative technique used for skeletal or soft tissue management at initial and definitive surgery, though fewer cases were performed as a two stage procedure. There was no difference in amputation rate in the two years. Length of stay was reduced from 21 days to 17, and 30 day mortality remained the same.

Conclusions: Our study shows this Major Trauma Centre was able to provide a trauma service in accordance to the BOAST4 guidelines despite the increased pressures of the COVID-19 pandemic.

Author Biographies

Rajan Choudhary, Department of Trauma and Orthopaedics, Newcastle Road, Stoke on Trent, United Kingdom

Trauma & Orthopedics

Madhumita Gupta, Department of Plastic Surgery, Royal Stoke University Hospital, Newcastle Road, Stoke on Trent, United Kingdom

Plastic Surgery

Shahidul Huq, Department of Plastic Surgery, Royal Stoke University Hospital, Newcastle Road, Stoke on Trent, United Kingdom

Plastic Surgery

Wareth Maamoun, Department of Plastic Surgery, Royal Stoke University Hospital, Newcastle Road, Stoke on Trent, United Kingdom

Plastic Surgery

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Published

2021-08-25

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Section

Original Research Articles