The Relationship of the COVID-19 pandemic with the Incidence and Management of Upper Limb Fractures: Double-Centre Study

Background: The COVID-19 pandemic brought about the placement of severe social restrictions in the United
Kingdom, limiting activity and impacting public behavior. Limited studies have been published on the relationship of
the coronavirus pandemic with the presentation and management of upper limb fractures. The aims of this study
were first to assess the change in the incidence of upper limb fractures at key points during the COVID-19 pandemic
such as the enactment and lifting of lockdowns, and second to evaluate the relationship between local COVID-19
burden and measures of service efficiency across our trust.
Methods: We undertook a retrospective analysis of all upper limb fracture referrals, admissions, and surgical procedures
from the 1st of March 2020 to the 28th of February 2021. Changes in upper limb fracture incidence were mapped to
significant changes in social restrictions. Measurements of service efficiency including time from admission to theatre
and length of stay for admitted upper limb fracture patients were mapped to local COVID-19 burden. Subgroup analysis
was undertaken to compare across age groups, including the pediatric population, all adults, and the elderly.
Results: The study involved 1251, 659, and 641 patients with upper limb fracture referrals, admissions, and procedures
across the trust, respectively. Referrals (n=128) and procedures (n=72) both peaked in August 2020. Admissions peaked
in both May and December 2020 (63 for both). Admissions and procedures both demonstrated a decrease in March and
April 2020 compared to the rest of the study period (40 and 38 admissions, as well as 48 and 29 procedures respectively).
Across the cohort, referrals and admissions did not demonstrate a statistically significant relationship with the relaxing of
social restrictions (P=0.504). There were statistically significant differences among referrals, admissions, and procedures
when stratifying patients by age (P=<0.001). Length of stay demonstrated an inverse relationship with COVID-19 burden
throughout the study period, with the shortest average length of stay recorded in months with the highest number of local
COVID-19 cases. The average time from injury occurrence to theatre increased during the winter months (P=0.001).
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. The
orthopedic service demonstrated adaptability in response to the local COVID-19 burden, and further research is
needed to determine what effect this had on clinical outcomes.
Level of evidence: IV