COVID 19 led to massive disruption of elective services across Scotland. This study was designed to assess the impact on elective service that the COVID-19 pandemic had, to what extent services have been restarted and the associated risks are in doing so.

This is a retrospective observational study. The primary outcomes are the number of operations completed, 30-day mortality, 30-day complication rates and nosocomial infection with COVID-19 compared to previous years. Data was collected from 4 regions across Scotland from 27th March 2020 - 26th March 2021. This was compared to the same time period the previous year.

3431 elective operations were completed in the year post-pandemic compared with 12255, demonstrating a reduction of 72%. Both groups had comparable demographics. Major joint arthroplasty saw a 72% reduction, with TKR seeing a reduction of 82%. Each of the 4 health boards were affected in a similar fashion. Nosocomial COVID-19 infection was 0.4% in the post covid group. 30 day mortality was the same at 0.1%. Total complications rose from 5.7% to 10.1% post covid.

This study shows that there has been a substantial reduction in elective activity across Scotland that is disproportionate to the level of COVID-19. The risk of developing COVID-19 from elective surgery is low at 0.4%, however all complications saw a significant rise. This is likely multifactorial. This study will inform decision makers in future pandemics, that it is safe to continue elective orthopaedic surgery and of the potential impact of cessation of services.

To study the outcome of complex proximal humeral fracture sequelae (Type 3 & 4) treated with the Delta III Total Shoulder Replacement (TSR) Prosthesis. This is a prospective outcome study involving 10 patients mean age (71.5 yrs). All patients failed conservative treatment of proximal humeral fractures. Mean time from injury to surgery was 10.5 (+/− 11.5) months. All patients underwent a Delta III TSR via McKenzie approach by a single surgeon. Patients were assessed clinically with Constant scores, asked whether they were satisfied, and radiologically with plain film radiographs. Since last review one patient has died. Mean time at follow up was 20.8 months post-operation (12 “32 months). Three patients had undergone early revision for dislocation. Since last review two patients have developed deep infection, one treated with washout and suction drain, one with removal of prosthesis. One patient has a clinical diagnosis of complex regional pain syndrome. Three patients are very happy with the outcome of surgery, one is happy, one unhappy and four very unhappy. The mean pre-operative Constant scores was 8.9 (2–15), at first review 44.4 (15–96) and now 35.8 (4–76). The mean pain score on a visual analogue scale (0–10) was 3.6 (0–10). Radiographs showed no progressive notching of the glenoid in any patient. Mean flexion was 93 degrees (10,170), mean abduction 61 degrees (10,100) and mean external rotation was “1 degrees (−20,20).

This is a new technique for treating proximal humeral fracture sequelae. Some individual results are excellent. There has been a high complication rate and a significant rate of poor results. At this time we cannot recommend the reverse geometry prosthesis for the treatment of proximal humeral fracture sequelae.