Introduction: There has been a significant rise in trainee-led trauma & orthopaedic multi-centre research collaborative projects globally. Since the start of the COVID-19 pandemic, more emphasis has been on global collaborative research efforts to tackle important research questions both related to COVID and otherwise.

Objective: To evaluate the number of trauma & orthopaedic trainee-led research collaborative projects that took part since the start of the COVID-19 pandemic in the UK.

Methods: This was a retrospective study that evaluated trauma & orthopaedic trainee-led national collaborative projects within the UK since the start of the COVID-19 pandemic lockdown (March 2020 to January 2021). Our exclusion criteria included any regional collaborative projects, projects that were started pre-COVID-19 and projects that involved other surgical specialities.

Results: In 2019, 0 trainee-led collaborative projects were commenced nationally in the UK. Since the COVID-19 pandemic, we identified 10 trainee-led collaborative trauma & orthopaedic projects with 1 being published so far. The level of evidence ranged between 3 and 4.

Conclusion: Our study highlights the feasibility of a trainee-led high quality collaborative research projects in trauma & orthopaedic in the UK, emphasising the growing contribution of trainees towards research and policymaking in our global trauma & orthopaedic health system. Wide-spread availability of new technological tools such as social media and centralised confidential online databases such as Redcap® facilitates such projects in terms of recruitment and data collection. We would, therefore, recommend expanding this trainee-led collaborative platform in the field of trauma & orthopaedics across in Europe and Worldwide.

Introduction: The World Health Organisation declared the COVID-19 pandemic in March 2020. In the United Kingdom (UK), the first wave of the pandemic is noted as Spring 2020 and the second as Autumn 2020. The aim of this study is to compare the pandemic’s impact on UK orthopaedic junior doctors’ training and well-being during both waves. Methods: A 28-item questionnaire was designed on Google Forms and circulated nationally via email to all Training Programme Directors to UK junior orthopaedic doctors from 22 March 2021 to 27 March 2021. Results: 72 participants, representing all training grades reported COVID-19 affected their surgical training. 42% and 30% trainees were re-deployed into another specialty during the first and second waves, respectively. Compared to the pre-pandemic era, 40% had access to face-to-face clinics in the first wave, this improved to 70% in the second wave. However, 46% and 67% trainees reported >75% reduction in theatre time compared to the pre-pandemic era, during the first and second waves, respectively. 91% stated a significant disruption to courses/conferences during both waves. 77% had access to scheduled teaching during the second wave, compared to 49% in the first wave. 53% reported their well-being has suffered due to burnout and stress. Discussion: During both waves, junior doctors’ training and wellbeing has been affected, with fewer theatre and clinic opportunities. Allocated trainee theatre lists and clinics could help current training. The pandemic’s full impact is still unknown but timely actions must be taken to ensure doctors’ education and well-being are well-supported.

Purpose: The H-index has been used to measure one’s research productivity and scholarly impact. Studies have shown that within orthopaedic surgery, higher H-index is associated with increased research funding and academic promotion. The purpose of this study was to determine what factors are associated with higher H-index among orthopaedic surgeons. Methods: We collected publicly available data on surgeons’ subspecialty training, gender, academic rank, region, and years in practice from institutional websites for academic orthopaedic programs in the United States. Each surgeons’ H-index was obtained from Scopus. Kruskal-Wallis test was used to determine differences in median H-index between orthopaedic subspecialties. Linear regression analysis of the impact of the independent variables on H-index was performed. Results: There were 2298 academic orthopaedic surgeons included in the study. The median H-index was significantly different between the different orthopaedic subspecialties (p<0.001). After controlling for confounding variables, adult reconstruction (β=0.08; p<0.01), sports medicine (β=0.07; p<0.01), spine (β=0.09; p<0.001), and upper extremity reconstruction (β=0.08; p<0.001) fellowships were all positively associated with H-index. Female surgeons had lower H-index compared to male surgeons (β=0.03; p=0.04). Both associate (β=0.13; p<0.001) and full professorship (β=0.57; p<0.001), as well as years in practice (β=0.11; p<0.001) were associated with higher H- index. Conclusion: Among academic orthopaedic surgeons, gender, academic rank, years in practice, and subspecialty selection were all independently associated with research productivity as measured with H-index. Surgeons who completed fellowships in adult reconstruction, upper extremity reconstruction, sports medicine, or spine were likely to have higher H-indices compared to their peers.

Introduction: Obesity is associated with increased perioperative complications in various surgeries. Yet, no data exists on whether obesity is related to an increased risk of perioperative complications in orthopedic surgeries. This study aims to explore the effect of BMI on the 30-day perioperative complications in patients undergoing one of the 25 most commonly performed orthopedic procedures. Methods: A retrospective cohort study was conducted using ACS-NSQIP database, where the 25 most commonly performed orthopedic procedures were identified. These patients were divided into five groups based on BMI: underweight (BMI< 18.5kg/m2), normal weight (BMI=18.5-24.9kg/m2), overweight (BMI=25-29.9kg/m2), mildly obese (BMI=30-34.9kg/m2) and moderately-to-severely obese (BMI≥35kg/m2). We calculated 30-day postoperative composite morbidity and mortality. Results: The majority of the 76,189 patients were overweight. Studied patients had an increased composite morbidity risk if underweight and if moderate-to-severely obese. The mortality rate was highest in the underweight group. The specific morbidities of the respiratory system and bleeding were more prevalent in the underweight group. Overweight and moderate-to-severely obese groups were at an increased risk of thromboembolism. Discussion: Our study showed that the highest risk of composite morbidity was in underweight patients. Underweight patients were older, had higher rate of preoperative comorbidities than normal-weight group, exhibited the outmost postoperative cardiovascular and pulmonary complications, and had an increased risk of postoperative mortality. Conclusion: Both the lowest and highest BMI values affected the risk of postoperative composite morbidity negatively. Normal as well as mildly high BMI seem to protect against postoperative morbidities with a few exceptions.

Since the COVID-19-pandemic, greater use of telemedicine, such as online-video-consultations (OVC), has been proposed. The aim of this study was to assess the willingness of orthopaedic trauma outpatients to conduct an OVC during the pandemic as opposed to before.
A paper-questionnaire was handed to all orthopaedic trauma outpatients of three European Level-1-trauma-centers between June and November 2019 and between April and July 2020. The questionnaire consisted of demographic data and five open and closed questions. Primary outcome was the difference in willingness to conduct an OVC between the preCOVID-19-cohort and the COVID-19-cohort. Sub-analysis was performed for gender, occupation and age-groups.
1400 patients (780 preCOVID-19; 620 COVID-19) were included. There were no demographic differences between the cohorts. There was no difference in willingness to conduct an OVC (57.6% preCOVID-19; 63.9% COVID-19; p=0.053). Patients aged 31-55 years showed greater willingness towards conducting an OVC than their younger and older counterparts. In the COVID-19-cohort, more patients stated that they would use the OVC for “personal questions” (55.2% vs. 44.4% p=0.001) and saw greater advantages like “no risk of infection” (55.2% vs. 44.4% p=0.001) and “availability from anywhere” (56.9% vs. 51.2%, p=0.032). Less patients from the COVID-19-cohort saw «no direct contact with the physician» (40.5% vs. 49.1%, p=0.001) and «relationship could change» (21.5% vs. 26.7%, p=0.024) as potential disadvantages.
The majority of participants would use an OVC. The COVD-19-pandemic has not increased the willingness significantly, but fear of infections has risen and direct contact with the physician plays a lesser role since the pandemic.

Introduction: There is little data on sports injuries and their impact on the future of young athletes. This study aims to evaluate sports injuries to verify those that can be prevented. Methods: Athletes from a youth soccer team who suffered sports injuries in two consecutive years were selected. Incomplete records were excluded. The population included was 73 athletes. The data was collected anonymously and confidentially. A retrospective cohort study was carried out with statistical analysis using the SPSS program. Results: The most frequent types of injuries were sprains 16.2%, contusions 13.5%, contractures 13.5% and strains 12.2%. Most injuries were traumatic 60.8%, located in the lower limbs 79.7% and occurred more in training 74.3%. There was also a higher prevalence of injuries at higher levels. Discussion: In this population, the most common injuries are sprains, strains and contusions with percentages similar to the literature 10-40%. It is also validated that 60-90% of all football injuries in young athletes are traumatic. There is controversy about the higher incidence of injuries being in games or training. In this population there is a higher incidence of injuries in training. Possibilities that justify this result are the existence of a greater number of athletes to participate in training than in games. Conclusion: Sports injuries can limit athlete participation and cause significant suffering and costs. Knowing the epidemiological data on the frequency and characteristics of injuries is essential to develop preventive measures. More prospective and randomized studies on sports injuries in young athletes are needed.

Introduction : Covid -19 pandemic is evolving and so far there are no studies to demonstrate if it has influenced the mortality in patients who undergo surgery for fractures. Our study analyses the influence of Covid on perioperative death in trauma patients in a rural hospital setting in UK .Methods : 156 consecutive patients with age more than 75 years , who were admitted for trauma surgery in Glangwili General Hospital at the height of second wave of covid pandemic between 20 November 2020 and 20 January 2021, were included in this study . The mortality of patients who died within 28 days of surgery was estimated and results were compared to a similar cohort of patients from 2019-2020. Results: A total of 41 out of 156 patients were found to be covid positive.14 patients died postoperatively , hence general overall mortality rate within 28 days of surgery for the year 2020-21 was 8.9% compared to 4% in 2019-20 .Out of 41 covid positive patients , 11 died within 28 days of surgery with mortality rate at 26.8% in covid positive trauma patients, i,e more than 1:4 chance of dying on catching covid .Furthermore, 90.9% covid positive patients who died had significant cardiac disease and proximal femoral fractures. Conclusion: There is a significant risk of dying in the perioperative period on getting infected with Covid for patients who are 75 years of age or older with associated cardiac comorbidities and who have sustained proximal femoral fractures.

Introduction: The SARS-CoV-2 (COVID-19) pandemic has had a profound impact on global health, including elective surgeries such as total joint arthroplasty (TJA). The purpose of this study is to evaluate the impact COVID-19 has on patients undergoing elective or urgent TJA.
Methods: An anonymous survey was completed by 405 patients who underwent TJA during the pandemic. Patients were surveyed for demographics, education prior to surgery, motivation for surgery, COVID-19 test results, fear of COVID-19 and perception of outcomes.
Results: 318 patients reported having elective surgery while 83 considered their surgery urgent (79.3% vs. 20.7%). Before surgery, 343 patients tested negative for COVID-19 (85.1%) while 1 person tested positive (0.25%) and 59 patients were not tested (14.7%). Patients who reported adequate COVID-19 education before surgery were more likely to have fear alleviated by proper PPE (64.3% vs. 26.3%), social distancing (42.0% vs. 19.7%), and testing (70.2% vs. 17.1%) vs those who reported no education. 366 patients were very satisfied or satisfied overall while 6 patients were dissatisfied or very dissatisfied (92.4% vs. 1.5%). Patients who reported adequate COVID-19 education were more likely to be very satisfied with their surgery compared to patients who received no education (81.0% vs 51.4%). Eleven patients (4.5%) reported either testing positive or feeling symptoms of COVID-19 within 90 days of surgery.
Discussion: Patients who felt adequately educated on COVID-19 prior to surgery were less fearful, and more satisfied with their treatment during the pandemic. Confirmed or presumed COVID-19 infection within 90 days of surgery was rare.