Epidemiology of paediatric lower extremity fractures in a tertiary care center in Switzerland

The Effect of COVID-19 on Pediatric Traumatic Orthopaedic Injuries: A Database Study

INTRODUCTION

Stay-at-home orders and other social distancing restrictions had a profound effect on the lives of children during the pandemic. This study characterizes pediatric orthopaedic injuries and in-hospital outcomes during the COVID-19 pandemic and compares them with pre-COVID patterns.

METHODS

A retrospective review of pediatric patients presenting to hospitals with Pennsylvania Trauma Systems Foundation designations was performed. All patients younger than 18 years who presented with orthopaedic injuries were included. Patient demographics, injuries, hospital stays, and mortality were compared between the COVID and pre-COVID cohorts.

RESULTS

Overall, 1112 patients were included. During the pandemic, more injuries occurred at home (44.7% versus 54.9%, P = 0.01) and fewer at sporting areas, parks, and pools (7.8% versus 1.6%, P < 0.01) as well as at schools (3.4% versus 0.5%, P = 0.03). Injuries caused by child abuse were more prevalent during the pandemic (5.6% versus 11.0%, P < 0.01). Finally, the COVID cohort had a longer mean hospital length of stay (3.1 versus 2.4 days, P = 0.01), higher mean number of ICU days (1.0 versus 0.7 days, P = 0.02), and higher mortality rate (3.8% versus 1.3%, P = 0.02).

DISCUSSION

Pediatric patients sustained injuries in differing patterns during the pandemic, but these led to worse hospital outcomes, including higher mortality rates.

Profiles of Children with Lower Extremity Fracture at Saiful Anwar Malang Regional General Hospital from January 2016 to August 2020

Musculoskeletal injuries in children are a common cause of 25% of children hospitalization. Previous research stated that five pediatric fractures had significant long-term consequences such as disability and activity restriction. In Indonesia, epidemiology studies have discussed the incidence of fracture in general sites, but only a few reported lower limb fractures. The authors expect this research to be used for lower extremities fractures in children’s epidemiologic descriptions. Between January 2016 until September 2020, we included 247 children under 18 years old based on inclusion criteria. The prevalence and fractures were reviewed for detail, such as sex, age, mechanism of injury, location of the fracture, and treatment. Data were analyzed using SPSS version 26. Most common injuries occur at 13-18 years old with 164 children (66.4%). Most of them were caused by traffic accidents, 210 cases (85.0%). Consequently, femur fractures are the most common fractures due to traffic accidents 53.8% (p<0.005). From common fracture sites in this study, plating is the common to use procedure than the others (52.3%). Therefore, we can conclude that MVA were the most common injury in children, and especially for fracture femur relevant with increasing age and plating methods is common to use method for this fracture

Collins, Bruegel, and the Games They Play

William Collins and Pieter Bruegel the Elder in their respective paintings, "Happy as a King" and "Children's Games" show children playing outdoors. The types of injuries these children could sustain in the 16th and 19th centuries are contrasted with sports related pediatric fractures in the present day.

The increase in paediatric orthopaedic trauma injuries following the end of the curfew during the COVID-19 period

PURPOSE

The aim of this study was to compare the injury patterns of orthopaedic trauma patients in the paediatric age group who presented to our hospital during and after lifting the curfew due to the pandemic, with the patients of the same age group who presented to our institution during the same time period last year.

METHODS

Patients, aged 0 years to 18 years, who presented to our clinic between 21 March 2020 and 31 May 2020 (during curfew) (Group A1, n = 111), between 01 June 2020 and 31 August 2020 (Group A2, n = 214) and during the same periods in 2019 Group B1 (n = 220) and Group B2 (n = 211) were included. Patients with pathological fractures, traumas occurring earlier than the aforementioned date range and those consulted while being hospitalized in another department were excluded from study. Patients' demographics, the department they presented to, the anatomical region affected by trauma, trauma mechanism, the location of trauma, the treatment applied and the length of hospital stay were recorded.

RESULTS

The prevalence of outdoor traumas (72.9% versus 61.1%), high-energy traumas (40.1% versus 26.5%), the rate of the patients treated with surgery (28% versus 17.1%) and the rate of admission to the emergency department (90.2% versus 58.3%) were significantly higher in Group A2 when compared with Group B2 (p < 0.05).

CONCLUSION

The significant increase was observed in the number of outdoor injuries, high-energy traumas and fracture patterns that require surgical treatment during the first three months following the lift of the curfew, in comparison with the corresponding dates from last year. We think that children's lower extremity muscle strength and neuromuscular control was decreased due to staying home for a prolonged period of time.

LEVEL OF EVIDENCE

Level III, Case-control study.