Aims The COVID-19 pandemic has changed the delivery of emergency orthopaedic fracture care, with focus on avoiding hospital admissions and minimising nosocomial virus transmission. We set out to reconfigure our service to best meet the needs of patients.

Methods Prior to the pandemic, patients with displaced fractures requiring manipulation routinely received treatment in the operating theatre. The pandemic posed several challenges to the continued delivery of this service following a reduction in theatre capacity. After discussion with multidisciplinary team members, it was agreed that where possible manipulations would be performed in fracture clinic at the point of the presentation. To facilitate this, the trust’s mini c-arm (fluoroscopy) was relocated. A standard operating procedure (SOP) was written to guide safe administration of analgesia for adults and children. Essential resuscitation equipment and airway trained doctor support were made available to ensure patient safety. Data was collected prospectively over a 28-day period and compared to the same period in 2019.

Results The mini c-arm was used on 34 patients in the fracture clinic setting. 82.4% patients received definitive treatment and 44.1% avoided admission for theatre. There were no adverse events. Compared to 2019, the number of patients undergoing fracture manipulation in theatre decreased by 66.7%. NHS reference costs were used to estimate a £8445 saving over the 28-day period.

Leadership Lessons The nature of the global pandemic required swift action to be taken to adapt our service to meet the needs of patients. We used the PDSA (plan, do, study, act) framework to implement this change. After discussion of the findings at our quality improvement meeting, an SOP has now been written to guide the continued running of the service. We wish to highlight this model of emergency orthopaedic fracture care to other trusts for use in the COVID-19 pandemic and beyond.