Background: With the emergence of the COVID-19 pandemic, most health-care personnel and resources are redirected to prioritize care for seriously-ill COVID patients . This situation may poorly impact our capacity to care for critically injured patients . We need to devise a strategy to provide rational and essential care to hand trauma victims whilst the access to theatres and anaesthetic support is limited . Our center is a level 1 trauma center, where the pandemic preparedness required reorganization of the trauma services . We aim to summarise the clinical profile and management of these patients and highlight, how we modified our practice to optimize their care .
Methods: This is a single-centre retrospective observational study of all patients with hand injuries visiting the Department of Plastic Surgery from 22nd March to 31st May 2020 . Patient characteristics, management details, and outcomes were analysed .
Results: A total of 102 hand injuries were encountered . Five patients were COVID-19 positive . The mean age was 28.9 ± 14.8 years and eighty-two (80.4 %) were males . Thirty-one injuries involved fractures/dislocations, of which 23 (74.2 %) were managed non-operatively . Seventy-five (73.5 %) patients underwent wound wash or procedure under local anaesthetic and were discharged as soon as they were comfortable . Seventeen cases performed under brachial-plexus block, were discharged within 24 hours except four cases of finger replantation/ revascularisation and one flap cover which were discharged after monitoring for four days . At mean follow-up of 54.4 ± 21.8 days, the rates of early complication and loss to follow-up were 6.9% and 12.7% respectively .
Conclusions: Essential trauma care needs to continue keeping in mind, rational use of resources while ensuring safety of the patients and health-care professionals . We need to be flexible and dynamic in our approach, by utilising teleconsultation, non-operative management, and regional anaesthesia wherever feasible.