DOI: 10.1093/bjs/znad258.113 ISSN:

527 BSSH Standards of Care in Hand Trauma: The Impact of COVID-19 on Timing to Treatment

A Elzagh, S Shah, K Amin, J Bedford
  • Surgery



To evaluate the compliance of our regional unit against the British Society for the Surgery of the Hand (BSSH) standards of care in hand trauma (BSSH, 2020) following an increase in our WALANT practice post-pandemic.


A retrospective audit of two parallel 6-month periods was undertaken in our unit in Greater Manchester. Group 1 (pre-pandemic) comprised of cases managed at our main site from September 2019 – February 2020. Group 2 (post-pandemic) consisted of patients managed under the newly devised regional and national WALANT guidance at our sister site between September 2020 – February 2021. Data collection involved cross-referencing multiple databases. Exclusion criteria included delayed presentation, no injury identified at time of surgery, re-rupture and re-operation.


Number of cases across the 2 study periods were almost identical (group 1 = 451, group 2 = 449). There was an improvement in compliance post-pandemic (78.86%) versus pre-pandemic (75.4%); this was not statistically significant (p = 0.283). We observed a significant improvement in compliance for patients undergoing extensor tendon repair (pre-pandemic = 68.97%, post-pandemic = 85.94%, p = 0.42). This was not the case for the other sub-groups (table 1). Crucially, we observed a >50% reduction in GA cases post-pandemic (14.92%) compared to pre-pandemic (66.08%).


Despite a significant reduction in anaesthetic team input, we have achieved similar levels of compliance as pre-pandemic across multiple domains whilst observing improved compliance for extensor tendons.

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