The Impact of the COVID-19 Pandemic and Lockdown on Adult Foot and Ankle Fractures Presenting to the Largest Trust in the United Kingdom

Upamanyu Nath; Amir Reza Akbari; Benyamin Alam; Rohan Dahiya; Anand Pillai

doi:10.7759/cureus.48262

The Impact of the COVID-19 Pandemic and Lockdown on Adult Foot and Ankle Fractures Presenting to the Largest Trust in the United Kingdom

Cureus. 2023 Nov 4;15(11):e48262. doi: 10.7759/cureus.48262. eCollection 2023 Nov.

Authors

Upamanyu Nath¹, Amir Reza Akbari², Benyamin Alam³, Rohan Dahiya⁴, Anand Pillai¹

Affiliations

¹ Trauma and Orthopaedics, Wythenshawe Hospital, Manchester, GBR.
² Medicine, King's Mill Hospital, Sutton-in-Ashfield, GBR.
³ Otolaryngology, Queen Elizabeth Hospital Birmingham, Birmingham, GBR.
⁴ Internal Medicine, Wythenshawe Hospital, Manchester, GBR.

Abstract

Background The COVID-19 pandemic induced unprecedented changes in medical practices, prompting a reassessment of their impact on adult foot and ankle fractures within the National Health Service (NHS). This study employs a retrospective observational approach, leveraging the Pathpoint™ eTrauma platform for a comprehensive analysis of prospectively collected data. Methods Data encompassing weekly fracture incidence, weekly surgical procedures, patient demographics, and mean wait time from injury presentation to surgery were systematically evaluated. The study population included all adults (18+) admitted during five distinct periods: pre-pandemic, national lockdown 1, post-lockdown, national lockdown 2, and national lockdown 3. Results An analysis of 434 foot and ankle fractures revealed that national lockdown 1 exhibited the lowest fracture incidence (4.97 per week) and surgeries performed (4.77 per week), reflecting a notable reduction in trauma cases and elective procedures. Conversely, post-lockdown displayed the highest fracture incidence (7.46 per week) and surgeries performed (6.31 per week), suggesting a resurgence in both trauma and elective surgical activities. The pre-pandemic cohort, characterized by the highest mean age (51.98 years) and mean wait time (8.74 days), served as a temporal baseline. Conclusion While the incidence of fractures decreased during all three national lockdowns compared to pre-pandemic or post-lockdown periods, a gradual increase was observed in subsequent lockdowns. Notably, mean wait times showed a significant reduction, reaching the lowest point (5.79 days) during national lockdown 3. These findings underscore the complex interplay between pandemic-related disruptions, evolving guidelines, and adaptive measures within the healthcare system, influencing the dynamics of foot and ankle fracture management.

Keywords: ankle; ankle fractures; covid 19; covid-19 lockdown; foot; foot & ankle surgery; foot and ankle fracture; nhs; ortho surgery; post-lockdown.