Impact of the COronaVIrus Disease 2019 lockdown on hand and upper limb emergencies: experience of a referred university trauma hand centre in Paris, France

What was the impact of COVID-19 restrictions on unintentional injuries, in Canada and globally? A scoping review investigating how lockdown measures impacted the global burden of unintentional injury

Background

Injuries are among the leading causes for hospitalizations and emergency department (ED) visits. COVID-19 restrictions ensured safety to Canadians, but also negatively impacted health outcomes, including increasing rates of certain injuries. These differences in trends have been reported internationally however the evidence is scattered and needs to be better understood to identify opportunities for public education and to prepare for future outbreaks.

Objective

A scoping review was conducted to synthesize evidence regarding the impact of COVID-19 restrictions on unintentional injuries in Canada, compared to other countries.

Methods

Studies investigating unintentional injuries among all ages during COVID-19 from any country, published in English between December 2019 and July 2021, were included. Intentional injuries and/or previous pandemics were excluded. Four databases were searched (MEDLINE, Embase, Web of Science, SPORTDiscus), and a gray literature search was also conducted.

Results

The search yielded 3,041 results, and 189 articles were selected for extraction. A total of 41 reports were included from the gray literature search. Final studies included research from: Europe (n = 85); North America (n = 44); Asia (n = 32); Oceania (n = 12); Africa (n = 8); South America (n = 4); and multi-country (n = 4). Most studies reported higher occurrence of injuries/trauma among males, and the average age across studies was 46 years. The following mechanisms of injury were reported on most frequently: motor vehicle collisions (MVCs; n = 134), falls (n = 104), sports/recreation (n = 65), non-motorized vehicle (n = 31), and occupational (n = 24). Injuries occurring at home (e.g., gardening, home improvement projects) increased, and injuries occurring at schools, workplaces, and public spaces decreased. Overall, decreases were observed in occupational injuries and those resulting from sport/recreation, pedestrian-related, and crush/trap incidents. Decreases were also seen in MVCs and burns, however the severity of injury from these causes increased during the pandemic period. Increases were observed in poisonings, non-motorized vehicle collisions, lacerations, drownings, trampoline injuries; and, foreign body ingestions.

Implications

Findings from this review can inform interventions and policies to identify gaps in public education, promote safety within the home, and decrease the negative impact of future stay-at-home measures on unintentional injury among Canadians and populations worldwide.

Hand Injuries During COVID-19 UK Lockdown: How Did the Pandemic Affect 1-Year Functional Outcomes?

BACKGROUND

The COVID-19 outbreak was declared a pandemic in March 2020, forcing the United Kingdom into a national lockdown. The aim was to evaluate the effect of this lockdown on hand injuries referred through the trauma and orthopedics virtual fracture clinic (VFC) service and their subsequent management given limited resources. This study also aimed to identify complications and evaluate functional outcomes.

METHODS

Patients referred through VFC at Queen Alexandra Hospital during April and May 2020 with hand injuries were analyzed. Isolated injuries to the carpus and wrist were excluded. Controls were compared over identical time spans prior to lockdown and after the restrictions were eased. Functional outcomes were measured using the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, at 12 months after injury.

RESULTS

There was a 68% reduction in referrals of hand injuries during lockdown. Lower numbers of sporting injuries were seen, in contrast to an increased rate of falls, crush injuries, and recreational cycling. Despite a higher number of patients being discharged from VFC during lockdown, there were no increased rates of complications from conservatively managed hand fractures. Eighty percent reported low QuickDASH scores with a median of 2.3. Satisfaction was high, with 73% either satisfied or very satisfied with their treatment and outcome.

CONCLUSION

This study demonstrates that there remains a burden of hand trauma during lockdowns, and therefore, service provision for future lockdowns should consider this. Most patients can be managed conservatively, and a high proportion can be discharged from VFC with low complication rates and high satisfaction.

The impact of SARS-Covid-19 pandemic on peripheral nerve surgery - A single centre report

OBJECTIVE

SARS-Cov-19 pandemic totally changed daily routine work in German hospitals. As hospital capacity was reduced, many surgeries were postponed or even cancelled. On March 25th 2020 the German Society of Neurosurgery (DGNC) published a statement in which urgent non-elective surgeries were defined for each neurosurgical domain, whereas elective interventions were deferred. The present work examines the impact of these Covid strategies focusing on patients with peripheral lesions who were conducted to our department during this period of time.

METHODS

All patients who underwent any peripheral nerve surgery at our department from January 2018 until December 2022, were included. The complete range of surgeries including peripheral nerve lesions was examined encompassing compression syndromes, traumatic lesions of brachial plexus, traumatic lesions and tumors of single peripheral nerves. The numbers of surgical procedures were compared before, during and after pandemic. Pearson correlation coefficient was analysed.

RESULTS

From 2018 to 2022 the total number of surgical procedures involving peripheral nerves included 2422 procedures. Compression syndromes made up the largest proportion (1433 operations, 59%), followed by peripheral nerve lesions (445 operations, 18%), peripheral nerve tumors (344 operations, 14%) and lesions of the brachial plexus (142 operations, 6%). The average was 40,5 interventions per month, the range was 7-63. Two declines in the number of peripheral nerve surgeries were noted during this period. The first was in April and May 2020 with an average drop of 65% and 41% respectively. In these months the average number of operations was 37. The second decrease was from October 2021 until January 2022, where number of surgeries was reduced by 16%, 36%, 83% and 18% with an average number of 50 operations. Both declines showed a significant and strong correlation with the lower number of compression syndrome treatments (r = 0.952, p < 0.001 and r = 0.968, p < 0.001), while no drop and no significant correlation was found in the treatment of traumatic peripheral nerve injuries (p = 0.769, r = 0.095 and p = 0.243, r = 0.366) and traumatic brachial plexus injuries (p = 0.787, r = 0.088 and p = 0.780, r = 0.09). A weak significant correlation was seen in the treatment numbers of peripheral nerve tumors (p = 0.017, r = 0.672 and p = 0.015, r = 0.67).

CONCLUSION

Covid-19 pandemic lead to a significant decrease in the number of nerve decompressions, since, according to the German Society of Neurosurgery, those were considered as elective surgeries.

The Impact of COVID-19 on the Utilization of Public Sector Radiological Services in the Western Cape Province of South Africa

Background Coronavirus (COVID-19) was officially declared a pandemic in March 2020 and has had a major impact on global healthcare services, including radiology. However, little is known about the full impact of COVID-19 on the utilization of diagnostic imaging in Africa's public healthcare sector. Objectives The objective of this study was to compare public sector diagnostic imaging utilization by modality for the whole Western Cape Province (WCP) of South Africa (SA), as well as its metropolitan and rural areas, in 2019 and 2020 in terms of the absolute number of investigations and investigations per 1000 people. Method We performed a retrospective analysis of Western Cape Government Department of Health and Wellness and Stats SA District Council 2021 Mid-Year Population Estimates data. All diagnostic imaging investigations performed in 2019 and 2020 were collated and stratified by imaging modality, geographic region (metropolitan/rural), and calendar year. Data are presented as the total number of investigations and investigations per 1000 people. We calculated mammography utilization for women aged 40-70 years and compared data for 2019 and 2020. Results Between 2019 and 2020, the provincial population increased by 1.9%, while total imaging investigations and investigations per 1000 people decreased by 19% (1,384,941 vs. 1,123,508, -261,433) and 20% (262/103 vs. 208/103), respectively. Total numerical decline was highest in plain radiographs (1,005,545 vs. 800,641, -204,904), accounting for more than three-quarters (78%) of the total reduction. Percentage decline was most pronounced for mammography, as utilization was almost halved (15.7/103 vs. 8.9/103, -43%), whereas computed tomography was the least impacted (17.9/103 vs. 16.7/103, -12%) with the remaining modalities decreasing between approximately one-quarter and one-fifth (magnetic resonance imaging = 26%, fluoroscopy = 25%, general radiographs = 23%, ultrasound = 16%, chest radiographs = 18%). Proportional metropolitan (-18.7%) and rural decreases (-19.3%) were similar. Conclusion COVID-19 had a substantial impact on WCP imaging services, decreasing overall radiological investigations by almost one-fifth. The greatest impact was on elective investigations, particularly mammography. Although the proportional impact was similar for the metropolitan and rural areas, COVID-19 nonetheless exacerbated existing discrepancies in imaging utilization between the geographical regions. The medium- and long-term clinical impacts of decreased imaging are still to be defined.

[The impact of COVID-19 on hand surgery: A French retrospective comparative study in COVID-19 and non-COVID-19 hand trauma centers]

Introduction

En 2020, la pandémie a divisé la France en zone COVID-19 et non COVID-19. L’objectif principal de notre étude était de comparer la variabilité de l’activité chirurgicale et de consultation de 2 centres SOS main entre la période de pandémie et hors pandémie. Les objectifs secondaires étaient d’identifier les patients à risque afin de développer des moyens de prévention en traumatologie de la main.

Méthodes

Il s’agit d’une étude rétrospective bi-centrique à visée épidémiologique sur les admissions aux urgences traumatologiques pendant le premier confinement français. Les données ont été comparées à la même période en 2019 (groupe contrôle). 2055 patients ont consulté pour un traumatisme de la main ou du poignet.

Résultats

En 2020, l’activité des centres SOS main a diminué de 35 % en zone COVID-19 contre 24 % en zone non COVID-19 par rapport à la même période en 2019 (p < 0,0001 IC95 6,5–15,6). En comparant 2019 et 2020, l’incidence des plaies a augmenté en zone COVID-19 (58 % vs 78 % p < 0,0001) et diminué en zone non COVID-19 (55 % vs 50 % p < 0,0001). Les plaies complexes (16 % vs 35 % p < 0,0001 et 15 % vs 17 % p < 0,0001) et les fractures ouvertes (8 % vs 14 % p 0,019 et 4,5 % vs 5,3 % p < 0,0001) ont augmenté dans les 2 zones pendant la pandémie. Le taux d’hommes travailleurs non manuels blessés lors d’accidents de la vie courante (76 % vs 36 % p < 0,0001) est majoré toute zone confondue.

Conclusion

Les traumatismes de la main et du poignet sont moins fréquents mais plus graves pendant la pandémie comparativement à la même période en 2019. En encourageant la population à être consciente des risques et des moyens pour les éviter, comme une meilleure information et le respect de consignes de sécurité, nous pourrions minimiser ces risques. Ces données peuvent être utiles à la planification de stratégies de prévention pour de futurs confinements.

Niveau de preuve

III ; étude cas contrôle.

The impact of COVID-19 on hand surgery: A French retrospective comparative study in COVID-19 and non-COVID-19 hand trauma centers

INTRODUCTION

In 2020, the pandemic divided France into two zones: COVID-19 and non-COVID-19. The main objective of our study was to compare the variability of surgical and emergency consultation activity amongst two hand trauma centers, between the pandemic period and outside the pandemic period. The secondary objective was to identify at-risk patients in order to develop preventative strategies in hand trauma.

METHODS

This bi-centric retrospective study considered the epidemiology of admissions to trauma centers during the first French lockdown. The data were compared to the same period in 2019 (control group). Two thousand and fifty-five patients underwent consultations for hand or wrist trauma.

RESULTS

The first French lockdown was associated with a 35% decrease in hand and wrist injuries in the COVID-19 zone versus 24% in the non-COVID-19 zone, compared to the same period in 2019 (p<0.0001, 95% CI: 6.5-15.6). Comparing 2019 and 2020, the incidence of wounds significantly increased in the COVID-19 zone (58% vs. 78%, p<0.0001) and significantly decreased in the non-COVID-19 zone (55% vs. 50%, p<0.0001). Complex wounds (16% vs. 35%, p<0.0001 and 15% vs. 17%, p<0.0001) and open fractures (8% vs. 14%, p=0.019 and 4.5% vs. 5.3%, p<0.0001) significantly increased in both zones during the pandemic. The rate of male, non-manual workers injured in domestic accidents (76% vs. 36%, p<0.0001) was significantly increased in all areas.

CONCLUSION

Hand and wrist trauma was less frequent but more severe during the pandemic compared to the same period in 2019. By encouraging the public to be aware of the risks and the means to avoid trauma, such as better information and compliance with safety instructions, we could minimize these risks. This data can be useful in planning preventative strategies for future lockdowns.

LEVEL OF EVIDENCE

III; case-control study.

[Impact of the COVID-19 pandemic context on the microbiological epidemiology and management of flexor sheath phlegmons]

Introduction

La pandémie liée au COVID-19 en France a récemment contribué à modifier le mode de vie des patients, ainsi que les modalités de prise en charge médicochirurgicale. Ces facteurs pourraient être la source de modification du spectre microbiologique, de la gravité ainsi que de l’évolutivité des phlegmons des gaines des fléchisseurs. L’objectif de cette étude était de faire un état des lieux épidémiologique et bactériologique de ces infections de la main et de comparer les données cliniques et microbiologiques avant et après la crise sanitaire due à la COVID-19.

Hypothèse

L’hypothèse de ce travail était que les phlegmons des gaines des fléchisseurs présentaient des caractéristiques microbiologiques spécifiques dans notre Centre hospitalier universitaire en milieu tropical, et que celles-ci ont également pu se modifier avec l’introduction récente de solution hydro-alcoolique liée à la pandémie COVID-19.

Matériel et méthodes

Entre janvier 2016 et décembre 2020, l’ensemble des données épidémiologiques préopératoires de nos patients ont été colligées. Le stade de gravité selon Michon, l’usage de solution hydro-alcoolique, ainsi que l’évolution clinique précoce, ont été recueillis. La cohorte était ensuite divisée en deux groupes afin de comparer les profils microbiologiques, la prise en charge et l’évolution clinique des patients en période pré-COVID de ceux en période post-COVID.

Résultats

Un total de 199 patients ont été inclus, 154 patients en période pré-COVID et 26 en période post-COVID. On retrouvait une majorité de SASM (58,3 %, n = 105) et 18,9 % de prélèvements négatifs (n = 34). Aucune différence statistiquement significative n’était retrouvée entre les deux groupes concernant les résultats bactériologiques. L’évolution clinique était jugée comme favorable dans 93,5 % des cas du groupe pré-COVID contre 80,8 % dans le groupe post-COVID (p = 0,046). L’utilisation de SHA (p < 0,0001) ainsi que le stade de sévérité initial selon Michon étaient significativement plus importants dans le groupe 2 (p = 0,04).

Discussion

La pandémie liée à la COVID-19 n’a pas montré de changement du spectre microbiologique, bien que l’usage de SHA se soit introduit dans nos vies quotidiennes. L’évolution clinique postopératoire était significativement moins favorable après l’apparition de la COVID et pourrait s’expliquer par une augmentation des cas ayant un stade de gravité initial plus avancé.

Niveau de preuve

IV, étude épidémiologique observationnelle.

Impact of the Covid-19 pandemic context on the microbiological epidemiology and management of flexor sheath phlegmons

INTRODUCTION

The COVID-19 pandemic in France has recently modified the patients' lifestyles, as well as methods of medical and surgical management. This could explain subsequent changes to the microbiological spectrum, the severity, as well as the scalability of phlegmons of the flexor tendon sheath. The objective of this study was to construct an epidemiological and bacteriological inventory of these hand infections, and to compare the clinical and microbiological data, before and after the COVID-19 pandemic.

HYPOTHESIS

The hypothesis of this work was that the phlegmons of the flexor tendon sheath presented specific microbiological characteristics in the tropical environment of our University Hospital Center, and that these characteristics could have changed with the recent introduction of hydro-alcoholic solution (HAS) associated to the COVID-19 pandemic.

MATERIAL AND METHODS

The preoperative epidemiological data of our patients were collected between January 2016 and December 2020. The stage of severity, according to the classification of Michon, the use of hydro-alcoholic solution, as well as the early clinical evolution were collected. The cohort was then divided into two groups in order to compare the microbiological profiles, the management and the clinical evolution of patients in the pre-COVID period with those in the post-COVID period.

RESULTS

A total of 199 patients were included, 154 patients in the pre-COVID period and 26 in the post-COVID period. We found a majority of MSSA (58.3%, N=105) and negative samples comprised 18.9% (N=34). No statistically significant difference was found between the two groups regarding the bacteriological results. The clinical course was judged to be favorable in 93.5% of cases in the pre-COVID group compared to 80.8% in the post-COVID group (p=0.046). The use of HAS (p<0.0001), as well as the initial stage of severity according to Michon, were significantly higher in group 2 (p=0.04).

DISCUSSION

The COVID-19 pandemic has not shown any change in the microbiological spectrum, despite the now daily use of HAS in everyday life. The postoperative clinical evolution was significantly less favorable after the onset of COVID and could be explained by an increase in cases with a more advanced initial stage of severity.

LEVEL OF EVIDENCE

IV, Observational epidemiological study.

Influence on emergency digit replantation and outcome assessment after COVID-19 virus nucleic acid testing normalization

Objective

The study aims to compare the implementation and prognosis of emergency digit replantation surgery before and after normalized corona virus disease 2019 (COVID-19) nucleic acid testing for patients taking emergency operation and to explore the influence of normalized COVID-19 nucleic acid testing on replantation surgery.

Method

Normalized COVID-19 nucleic acid testing for patients taking emergency operation has been carried out since 1 August 2021 at our hospital, which means each patient who needs emergency surgical treatment has to obtain either positive or negative results of COVID-19 nucleic acid before entering the operating room. This research reviewed and compared the prognosis of the injured extremity that had emergency severed digit replantation between June and September 2021, at the Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, and analyzed the impact of normalized COVID-19 nucleic acid testing on the outcome of the replanted fingers of different severity using disability of arm-shoulder-hand (DASH) and hand injury severity scoring (HISS) scoring systems.

Results

A total of 54 cases with 74 severed replanted phalanges were included replanted by the research group between 1 August and 30 September 2021, without any COVID-19 suspected/confirmed case detected. Compared with previous period (1 June to 31 July, 2021), although the interval between emergency visits and emergency replantation did increase significantly after normalized COVID-19 nucleic acid testing [(3.83 ± 0.94) to (1.77 ± 0.67) h, P < 0.05], we observed no significant difference in the improvement rate of the DASH scoring of the disabled upper extremity 3-month postoperatively (P = 0.538) nor in the complication rate (P = 0.344). Moreover, there was no significant difference in the improvement rate of the DASH scoring of the disabled upper extremity 3-month postoperatively in patients with different traumatic severities before and after normalized COVID-19 nucleic acid testing (moderate P = 0.269, severe P = 0.055, major P = 0.149).

Conclusion

Despite the preoperative delay, the policy of COVID-19 nucleic acid testing normalization does not have explicit influence on the short-term outcomes of emergency digit replantation surgery. With this evidence, microsurgeons could pay attention to the patients' anxiety and spend more effort in comforting them during the prolonged preoperative wait. These insights may have implications for other emergency department resource management whenever a social crisis occurs.

Changes in ambulance departures for assault calls during COVID-19 pandemic restrictions

Restrictions related to COVID-19 changed the daily behavior of people, including the expression of violence. Although an increased incidence of violent behavior, especially domestic violence, was expected during the pandemic, retrospective analyses have yielded mixed results. Records of ambulance departures to address injuries caused by assaults in the Pilsen region, Czech Republic, during the restrictive measures during the national state of emergency were compared to data from 3 previous years using general linear models. The number and severity of assaults were analyzed for the whole sample and separately for patients of either sex, for residential or nonresidential locations, and for domestic violence. Controlling for the seasonal effects, the number of assaults decreased by 39% during the pandemic restrictions compared to the 3 previous years. No difference was found between the effects of restrictions on assaults resulting in an injury of a male or female patient. The decrease was specifically pronounced in the sample of assaults in nonresidential locations, while no effect of restrictions was observed in assaults in residential locations and domestic assaults. Pandemic restrictions were associated with a decreased incidence of violent assaults that required ambulance services. Although the incidence decreased especially in those assaulted outside of their homes, we found no support for an increase in domestic violence or violence against women. Pandemic restrictions may have served as a protective rather than a risk factor for assaults severe enough to warrant a call for ambulance services.

The Relationship of the COVID-19 pandemic with the Incidence and Management of Upper Limb Fractures: Double-Centre Study

Background

The COVID-19 pandemic brought about the placement of severe social restrictions in the United Kingdom, limiting activity and impacting public behavior. Limited studies have been published on the relationship of the coronavirus pandemic with the presentation and management of upper limb fractures. The aims of this study were first to assess the change in the incidence of upper limb fractures at key points during the COVID-19 pandemic such as the enactment and lifting of lockdowns, and second to evaluate the relationship between local COVID-19 burden and measures of service efficiency across our trust.

Methods

We undertook a retrospective analysis of all upper limb fracture referrals, admissions, and surgical procedures from the 1^st of March 2020 to the 28^th of February 2021. Changes in upper limb fracture incidence were mapped to significant changes in social restrictions. Measurements of service efficiency including time from admission to theatre and length of stay for admitted upper limb fracture patients were mapped to local COVID-19 burden. Subgroup analysis was undertaken to compare across age groups, including the pediatric population, all adults, and the elderly.

Results

The study involved 1251, 659, and 641 patients with upper limb fracture referrals, admissions, and procedures across the trust, respectively. Referrals (n=128) and procedures (n=72) both peaked in August 2020. Admissions peaked in both May and December 2020 (63 for both). Admissions and procedures both demonstrated a decrease in March and April 2020 compared to the rest of the study period (40 and 38 admissions, as well as 48 and 29 procedures respectively). Across the cohort, referrals and admissions did not demonstrate a statistically significant relationship with the relaxing of social restrictions (P=0.504). There were statistically significant differences among referrals, admissions, and procedures when stratifying patients by age (p =<0.001). Length of stay demonstrated an inverse relationship with COVID-19 burden throughout the study period, with the shortest average length of stay recorded in months with the highest number of local COVID-19 cases. The average time from injury occurrence to theatre increased during the winter months (P=0.001).

Conclusion

There is a relationship between changes in social restrictions and the incidence of upper limb fractures. These changes also had differing impacts on upper limb fracture rates when stratifying by patient age groups. The orthopedic service demonstrated adaptability in response to the local COVID-19 burden, and further research is needed to determine what effect this had on clinical outcomes.

The effect of the COVID-19 pandemic lockdown measures on plastic, reconstructive and hand surgery emergency presentations – A comparative retrospective study in a regional referral center in Germany

Background

Methods

Results

Conclusions

•

The COVID-19 lockdown caused a shift in surgical emergency case presentations.

•

Increasing domestic and decreasing recreational and work injuries were noted.

•

Middle-aged females were at high risk to sustain injuries during lockdown.

•

Hand injuries showed consistent severity and hospital admission rates.

•

Resource allocation remains crucial in future pandemic waves.

Violent behavior and the COVID-19 lockdowns: a nationwide register-based study

OBJECTIVES

The primary aim was to test the hypothesis that physical interpersonal violence is decreased during the lockdown period in comparison with comparable control periods. The secondary aims were to explore the effects of gender and alcohol consumption on the violence during the lockdown.

METHODS

Nationwide records of hospitalizations secondary to an assault were analyzed using quasipoisson regression. Assault rates in two lockdown periods, defined as a national emergency state, were compared to baseline data between 2017 and 2020, controlling for seasonal fluctuations and pandemic-related effects other than lockdown. To validate the findings on independent data, differences between lockdown and baseline in Police records of violent criminality between 2017 and 2021 were examined using one-way ANOVA.

RESULTS

The rates of hospitalizations secondary to an assault decreased substantially during lockdowns (IRR = .43; P < .001) and the duration of lockdown did not affect assault rates (P = .07). The decrease in assault rates was more pronounced in males than females (IRR = .77; P < .05) and was weakened in patients with history of alcohol abuse (IRR = 1.83; P < .001). Violent crime rate decreased by 19% during the lockdowns compared to prepandemic baseline (P < .001).

CONCLUSION

We found that physical interpersonal violence decreased during the COVID-19 lockdown periods. The reduction is significantly greater in males. Emerging evidence suggests an increased risk of alcohol use and intoxication during the lockdowns. Violent crime rate decreased during the lockdown.

Impact of COVID-19 pandemic on hand injuries

BACKGROUND

The aim of the study was to evaluate etiologies of hand injuries in emergency department (ED), to compare the etiologies of hand injuries at the time of this study with the previous year, to assess whether novel coronavirus-2019 (COVID-19) pandemic affected the treatment decisions, and to investigate the COVID-19 infection rate within the first 14 days after admission.

METHODS

A total of 229 patients admitted to ED with hand injury between March 15 and April 30, 2020, were included in the study. The control group consisted of 439 ED admissions with hand injury in the previous year (March 15-April 30, 2019). Data including age, sex, cause of trauma, treatment, and COVID-19 infection status within 14 days after ED admission were compared between groups.

RESULTS

The mean age was 32.30±15.63 years in the study group and 30.85±18.54 years in the control group. The number of patients consulted to the surgery department decreased by 52.6% and the number of patients admitted to ED with hand injuries de-creased by 47.6% during the pandemic, compared to the previous year (p=0.0001). The incidence of home accidents increased and the glass cuts and penetrating/perforating injuries were the most common causes during the pandemic most of which occurred at home.

CONCLUSION

The COVID-19 pandemic-mandated social restrictions led to a significant decrease in the number of ED admissions with hand injuries and the type of injuries. The incidence of home accidents increased with more time spent indoors. This study may be a useful guide for ED admissions of hand injury cases and management planning in the current and future pandemics.

The 1 Year Effect of COVID-19 on Plastic Surgery Trauma at a Level One Trauma Centre: A Retrospective Review

Introduction: Since the onset of the COVID-19 pandemic, Canada has seen significant societal and health changes leading to the closures of many businesses and shifts in the daily activities of many Canadians. Despite these changes and a sharp drop in the number of patients attending emergency departments across British Columbia (BC), little change was noted in the use of protected plastic surgery trauma time at a level one trauma centre surveyed in BC. The purpose of this study was to analyze and compare the changes in plastic surgery-related trauma cases before and after the onset of the COVID-19 pandemic, both in etiology and case description. Methods: A retrospective medical chart review was performed, evaluating all of the participating surgeon's trauma slates in the year before and after April 1, 2020. Patient demographics, etiology, injury location, diagnosis, and surgical timing were all recorded and analyzed using an interrupted time-series statistical model. Results: No significant difference was observed in any of the recorded categories across the 2 time periods. Slight increases were noted in workplace injuries, assaults, and home-related machinery injuries. Conclusion: The lack of significant change in workplace injuries likely stemmed from the high number of factories and industrial plants present in our health region, as these jobs lacked the ability to work from home. The results of this study show that the demand for trauma-related plastic surgery care is independent of an overall decrease in hospital admissions and therefore should be planned and budgeted for accordingly.

Impact of the earthquake during COVID-19 lockdown on fracture admission at a tertiary trauma centre in Croatia

PURPOSE

To determine the impact of an earthquake during COVID-19 lockdown on fracture admission at a tertiary trauma centre in Croatia.

METHODS

A case-control study was performed at the tertiary trauma centre registry. Two different periods were studied. The case group included a period during COVID-19 lockdown right after the earthquakes until the end of the confinement period in Croatia. And the control group corresponded to the equivalent period in 2019. We identified all consecutive patients who were admitted due to urgent care requirements for the musculoskeletal trauma. Patient's demographic data and admitting diagnoses were assessed. Data were analyzed by statistical procedures using the program MedCalc statistical software version 16.4.3.

RESULTS

We identified 178 emergency admissions due to musculoskeletal trauma. During the COVID-19 lockdown and post-earthquake period, there was a drastic reduction in total admissions (359 vs. 662; p < 0.0001) with an increased proportion of trauma admissions within the emergency admissions (34.9% vs. 26.5%; p = 0.02926, Z = -2.1825). Furthermore, in the case group there was a significant increase in hospital admissions due to ankle/foot trauma (11 vs. 2, p = 0.0126) and a trend towards a decrease in the admissions due to tibia fractures (5 vs. 12, p = 0.0896), however without statistical significance. Also, an increased proportion of women within the group of femoral fractures in both case group (81.6% vs. 52.6%, p = 0.00194, Z = 3.1033) and the control group (82.3% vs. 60.5%, p = 0.0232, Z = 2.2742) was observed. In both analyzed periods, the osteoporotic hip fracture was the most common independent admitting diagnosis.

CONCLUSION

It is crucial to understand how natural disasters like earthquakes influence the pattern of trauma admissions during a coexisting pandemic. Accordingly, healthcare systems have to be prepared for an increased influx of certain pathology, like foot and ankle trauma.

One Year of COVID-19: Lessons Learned in a Hand Trauma Center

2020 will be remembered worldwide as the year of COVID-19 outbreak. The onset of this pandemic abruptly changed everybody’s life and, in a particular manner, doctors’ lives. Our hand surgery department became rapidly one of the first COVID-19-specialized wards in Italy, impacting considerably the authors’ routines and activities. In this paper, the authors focus on how the demographics of patients with hand trauma changed and how they had to modify their activity. The authors retrospectively took into consideration all patients reaching their emergency department (ED) with hand trauma between 9 March 2020 (the day of the beginning of the first lockdown in Italy) and 8 March 2021 and compared them to those who reached the ED in the three previous years. Authors have analyzed the number of patients, their gender and age, the severity of their trauma, where the trauma occurred, the type of lesion, the percentage of patients who underwent surgery, and the percentage of patients who had an emergency admission. In the last year, the number of patients reaching the ED for a hand trauma has been reduced by two thirds (975 patients during the past year), the mean age of those patients has slightly increased, the severity of cases has increased, places of trauma and type of lesions have changed, and, lastly, the percentage of patients needing surgery who were admitted immediately has increased. This paper shows how the type of patients reaching the ED changed and discusses how surgeons evolved and modified their habits in treating those patients during the first lockdown and the year that followed.

Hüftfrakturinzidenz und Lockdown: Gibt es Zusammenhänge?

Zur Eindämmung der COVID-19-Pandemie wurde in Österreich bereits mehrfach ein Lockdown verhängt. Durch die häusliche Isolation und dadurch reduzierte physische Aktivität könnte die Frakturhäufigkeit initial positiv beeinflusst werden, aber mittel- bis langfristig aufgrund eines reduzierten Trainingsstatus und verringerter Koordinationsfähigkeit, welche zu einem erhöhten Sturz- und damit Frakturrisiko führen, steigen. Basierend auf Daten der österreichischen Allgemeinen Unfallversicherungsanstalt (AUVA) zeigte sich die Häufigkeit von Hüftfrakturen im Zeitraum des ersten Lockdowns (16. März bis 31. Mai 2020) unverändert im Vergleich zu den gleichen Zeiträumen der Jahre zuvor, jedoch ergab eine Subanalyse eine reduzierte Frakturrate bei Frauen in der Altersgruppe 50-69 Jahre während des ersten Lockdowns verglichen mit dem gleichen Zeitraum des Jahres 2018.

[The incidence of hand trauma the COVID-19 epidemic setting]

OBJECTIVES

In France, a lockdown was enforced from March 17 to May 11, 2020. It was renewed with different modalities from April 3 to May 3, 2021. Our objective was to compare the epidemiology of hand and wrist trauma injuries during these periods to a control period, with the hypothesis of a decreased incidence of hand and wrist trauma.

METHODS

Patients consulting at a trauma emergency center of a university hospital labeled SOS-Mains were included during lockdowns, and were compared with a control group who consulted during an equivalent period in 2019. We retrospectively collected demographic and clinical data in relation to hand and wrist injuries.

RESULTS

During lockdowns, there was an increase in these injuries relative to the total number of patients (from 16% to 22% and 18%). We found a decrease during the first lockdown in the number of fractures, amputations, burns, infections, injuries secondary to a work accident and isolated wounds but a significantly higher proportion of tendon and vasculonervous injuries in the first lockdown (12% vs. 4%).

CONCLUSIONS

In first lockdown, the incidence of hand and wrist injuries decreased, but there was an increase in tendon and microsurgical injuries. This may be explained by the change in leisure activities. This underlines the importance of preventive measures concerning the risks related to some activities (use of sharp/motorized tools) in this context of health crisis.

Impact of the SARS-CoV-2 pandemic on trauma care: a nationwide observational study

Purpose

The SARS-CoV-2 pandemic severely disrupted society and the health care system. In addition to epidemiological changes, little is known about the pandemic’s effects on the trauma care chain. Therefore, in addition to epidemiology and aetiology, this study aims to describe the impact of the SARS-CoV-2 pandemic on prehospital times, resource use and outcome.

Methods

A multicentre observational cohort study based on the Dutch Nationwide Trauma Registry was performed. Characteristics, resource usage, and outcomes of trauma patients treated at all trauma-receiving hospitals during the first (W1, March 12 through May 11) and second waves (W2, May 12 through September 23), as well as the interbellum period in between (INT, September 23 through December 31), were compared with those treated from the same periods in 2018 and 2019.

Results

The trauma caseload was reduced by 20% during the W1 period and 11% during the W2 period. The median length of stay was significantly shortened for hip fracture and major trauma patients (ISS ≥ 16). A 33% and 66% increase in the prevalence of minor self-harm-related injuries was recorded during the W1 and W2 periods, respectively, and a 36% increase in violence-related injuries was recorded during the INT. Mortality was significantly higher in the W1 (2.9% vs. 2.2%) and W2 (3.2% vs. 2.7%) periods.

Conclusion

The imposed restrictions in response to the SARS-CoV-2 pandemic led to diminished numbers of acute trauma admissions in the Netherlands. The long-lasting pressing demand for resources, including ICU services, has negatively affected trauma care. Further caution is warranted regarding the increased incidence of injuries related to violence and self-harm.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00068-022-01891-5.

Effect of the COVID-19 pandemic at a major Danish trauma center in 2020 compared with 2018-2019: A retrospective cohort study

Background

The COVID‐19 pandemic demanded changes in societal behavior and health care worldwide. Previous studies have compared trauma patient admissions in COVID‐19‐related lockdowns to prior years. This study describes the COVID‐19 impact on trauma patient admissions during entire 2020 at a major trauma center in Denmark.

Methods

We retrospectively analyzed trauma patients received by a trauma team and admitted at Aarhus University Hospital in 2020 compared with 2018–2019. The incidence of injuries, mechanism of injury, 30‐day mortality, and Injury Severity Score (ISS) were investigated.

Results

The incidence of minor injuries (ISS 1–15) increased by 24% in 2020 compared with 2018–2019 (incidence rate ratio 1.24 [95% CI: 1.11–1.39]). The incidence of severe injuries (ISS >15) in 2020 did not change compared with 2018–2019 (incidence rate ratio 0.97 [95% CI: 0.80–1.17]). The 30‐day mortality was similar in 2020 compared with 2018–2019. Comparing 2020 with 2018–2019, the risk ratio of traffic injuries decreased (0.90 [95% CI: 0.82–0.99]), risk ratio for fall injuries was 1.13 (95% CI: 0.97–1.30), for violence 1.13 (95% CI: 0.51–2.50), and for self‐harm 1.94 (95% CI: 0.95–3.94). During the first lockdown of 2020, trauma team activations declined from 49.5 to 42 and the risk ratio for traffic injuries was 0.74 (95% CI: 0.50–1.10) compared with the same period in 2018–2019.

Conclusion

The incidence of minor injuries increased, but the incidence of severe injuries was similar in 2020 compared with 2018–2019. Societal restrictions might alter the mechanism of injuries. The first lockdown indicated an association with reduced traffic injuries.

Impact of the National Lockdown Due to the COVID-19 Pandemic On Upper Limb Trauma Workload in Central London: A Multi-Centre Longitudinal Observational Study During Implementation and Ease of National Lockdown

BACKGROUND

This study assessed the impact of the COVID-19 pandemic on acute upper limb referrals and operative case-mix at the beginning and ease of British lockdown.

METHODS

A longitudinal multicentre observational cohort study was conducted for both upper limb trauma referrals and operative case-mix over a 12-week period (6 weeks from the beginning and 6 weeks from the ease of the national lockdown). Statistical analysis included median (± median absolute deviation), risk and odds ratios, and Fisher's exact test to calculate the statistical significance, set at p ≤ 0.05.

RESULTS

There was a 158% (n = 456 vs. 177) increase in upper limb referrals and 133% (n = 91 vs. 39) increase in the operative trauma caseload at the ease of lockdown compared with its commencement. An increase in sporting injuries was demonstrated (p=0.02), specifically cycling (p=0.004, OR=2.58). A significant increase in COVID-19 testing was demonstrated during the ease of lockdown (p=0.0001) with more patients having their management changed during the beginning of the pandemic (9.6% vs. 0.7%, p=0.0001). Of these patients, 47% went on to have delayed surgery within 6 months. No patients who underwent surgery tested positive for COVID-19 infection within 14 days post-operatively and no mortalities were recorded at 30 days.

CONCLUSION

The ease of lockdown has seen upper limb referrals and operations more than double compared to early lockdown. With no patients testing positive for COVID-19 within 14 days of the procedure, this demonstrates that having upper limb surgery during the current pandemic is safe.

Natural language processing of radiology reports to investigate the effects of the COVID-19 pandemic on the incidence and age distribution of fractures

OBJECTIVE

During the COVID-19 pandemic, the number of patients presenting in hospitals because of emergency conditions decreased. Radiology is thus confronted with the effects of the pandemic. The aim of this study was to use natural language processing (NLP) to automatically analyze the number and distribution of fractures during the pandemic and in the 5 years before the pandemic.

MATERIALS AND METHODS

We used a pre-trained commercially available NLP engine to automatically categorize 5397 radiological reports of radiographs (hand/wrist, elbow, shoulder, ankle, knee, pelvis/hip) within a 6-week period from March to April in 2015-2020 into "fracture affirmed" or "fracture not affirmed." The NLP engine achieved an F₁ score of 0.81 compared to human annotators.

RESULTS

In 2020, we found a significant decrease of fractures in general (p < 0.001); the average number of fractures in 2015-2019 was 295, whereas it was 233 in 2020. In children and adolescents (p < 0.001), and in adults up to 65 years (p = 0.006), significantly fewer fractures were reported in 2020. The number of fractures in the elderly did not change (p = 0.15). The number of hand/wrist fractures (p < 0.001) and fractures of the elbow (p < 0.001) was significantly lower in 2020 compared with the average in the years 2015-2019.

CONCLUSION

NLP can be used to identify relevant changes in the number of pathologies as shown here for the use case fracture detection. This may trigger root cause analysis and enable automated real-time monitoring in radiology.

Geriatric Proximal Femur Fractures During the Covid-19 Pandemic - Fewer Cases, But More Comorbidities

Background:

The COVID-19 pandemic is challenging healthcare systems worldwide. This study examines geriatric patients with proximal femur fractures during the COVID-19 pandemic, shifts in secondary disease profile, the impact of the pandemic on hospitalization and further treatment.

Methods:

In a retrospective monocentric study, geriatric proximal femur fractures treated in the first six months of 2020 were analyzed and compared with the same period of 2019. Pre-traumatic status (living in a care home, under supervision of a legal guardian), type of trauma, accident mechanism, geriatric risk factors, associated comorbidities, time between hospitalization and surgery, inpatient time and post-operative further treatment of 2 groups of patients, aged 65-80 years (Group 1) and 80+ years (Group 2) were investigated.

Results:

The total number of patients decreased (70 in 2019 vs. 58 in 2020), mostly in Group 1 (25 vs. 16) while the numbers in Group 2 remained almost constant (45 vs. 42). The percentage of patients with pre-existing neurological conditions rose in 2020. This corresponded to an increase in patients under legal supervision (29.3%) and receiving pre-traumatic care in a nursing home (14.7%). Fractures were mostly caused by minor trauma in a home environment. In 2020, total number of inpatient days for Group 2 was lower compared to Group 1 (p = 0.008). Further care differed between the years: fewer Group 1 patients were discharged to geriatric therapy (69.6% vs. 25.0%), whereas in Group 2 the number of patients discharged to a nursing home increased.

Conclusions:

Falling by elderly patients is correlated to geriatric comorbidities, consequently there was no change in the case numbers in this age group. Strategic measures to avoid COVID-19 infection in hospital setting could include reducing the length of hospital stays by transferring elderly patients to a nursing home as soon as possible and discharging independent, mobile patients to return home.

Violent trauma as an indirect impact of the COVID-19 pandemic: A systematic review of hospital reported trauma

INTRODUCTION

The COVID-19 pandemic has exacerbated many social conditions associated with violence. The objective of this systematic review was to examine trends in hospital reported violent trauma associated with the pandemic.

METHODS

Databases were searched in using terms "trauma" or "violence" and "COVID-19," yielding 4,473 records (2,194 de-duplicated). Exclusion criteria included non-hospital based studies and studies not reporting on violent trauma. 44 studies were included in the final review.

RESULTS

Most studies reported no change in violent trauma incidence. Studies predominately assessed trends with violent trauma as a proportion of all trauma. All studies demonstrating an increase in violent trauma were located in the United States.

CONCLUSIONS

A disproportionate rise in violence has been reported within the US. However, most studies examined violent trauma as a proportion of all trauma; results may reflect relative changes from lockdowns. Future studies should examine rates of violent trauma to provide additional context.

[Impact of the COVID-19 crisis in Spring 2020 on trauma case numbers of an academic teaching hospital in Stuttgart : Trauma during a pandemic]

BACKGROUND

To cope with the COVID-19 outbreak in Germany, the government imposed a lockdown, which led to restrictions and lifestyle changes for the population.

PURPOSE

This study aimed to evaluate the impact of the lockdown on activities causing trauma and the consultation in emergency rooms.

MATERIAL AND METHODS

All consecutive trauma patients consulting the Emergency Department of the Marienhospital Stuttgart (MHS), Germany, during the 6 weeks preceding the lockdown, during and after the lockdown were included. The time and type of consultation, treatment received, Manchester triage score, type of trauma, the anatomical region of the injury as well as demographic data were reported and compared.

RESULTS

The study included 551 cases during lockdown, 943 cases before and 783 cases after the lockdown. We observed a reduced caseload during the lockdown of 41.6% compared to before and of 29.7% compared to after (p < 0.001). Patients were on average older in the observation group than in both control groups (before : 51.5 years, lockdown: 56.1 years, after: 51.6 years) (p < 0.001). Injuries to the head and neck were constant (25.0%, 25.4%, 25.5%). We noticed lower limb injuries decreasing (26.1%, 22.3%, 22.7%) and upper limb injuries increasing (25.5%, 31.8%, 30.1%). A decrease in sports injuries (11.1%, 5.1%, 9.1%) and work accidents (16.1%, 10.7%, 12.8%) resulted in more domestic accidents (30.4%, 52.5%, 31.8%). Self-referral decreased (67.7%, 53.2%, 60.3%) while referral via paramedics increased (28.3%, 38.7%, 35.6). Blunt trauma was the most common cause of injury (55.6%, 61.0%, 55.3%). Indications for surgery were higher (16.8%, 21.6%, 14.0%).

CONCLUSION

The lockdown and restrictions in personal life and daily routine had an impact on the frequency, etiology and management of trauma patients in Stuttgart.

The Impact of COVID-19 Lockdown on Injuries in Saudi Arabia: Results From a Level-I Trauma Center

Background: The COVID-19 pandemic has placed an enormous strain on global health. Due to precautionary measures, the epidemiology of health conditions may have been affected. Saudi Arabia imposed a lockdown order on March 25, 2020. This study investigated the impact of the pandemic lockdown on injuries in a level-I trauma center in King Abdulaziz Medical City, Riyadh, Saudi Arabia. Methods: This retrospective study identified all injured patients seeking emergency care during the lockdown period (March 25-June 21, 2020) and a similar period in two previous year (March 25-June 21) 2018 and 2019. The collected data included patients' demographics, injury types, mechanisms, and health outcomes. Results: Two hundred sixty nine injured patients sought emergency care during the lockdown, while 626 and 696 patients were treated in the same period of 2018 and 2019, respectively. There was a significant reduction in motor vehicle crashes (OR: 0.47; 95% CI: 0.31-0.73) and burns (OR: 0.24; 95% CI: 0.08-0.66), coupled with a significant increase in assault injuries (OR: 2.20; 95% CI: 1.30-3.74) in the lockdown period compared to 2019. Apart from the intensive care unit (ICU) admission and hospital length of stay, there were no differences between the two periods in the health outcomes. ICU admission was significantly reduced by 57% during the lockdown period (OR: 0.43; 95% CI: 0.22-0.83). Mechanisms of injuries were not significant predictors of deaths or ICU admission or both in the lockdown period. Conclusion: The COVID-19 lockdown had a clear impact on the volume and mechanisms of injuries. The findings highlight that injury risk factors are modifiable and emphasize the importance of public health measures for preventing injuries and the significance of maintaining trauma services capacity during pandemics.

Decreased number of deaths related to severe traumatic brain injury in intensive care unit during the first lockdown in Normandy: at least one positive side effect of the COVID-19 pandemic

Background

The COVID-19 pandemic has led to severe containment measures to protect the population in France. The first lockdown modified daily living and could have led to a decrease in the frequency of severe traumatic brain injury (TBI). In the present study, we compared the frequency and severity of severe TBI before and during the first containment in Normandy.

Methods

We included all patients admitted in the intensive care unit (ICU) for severe TBI in the two tertiary neurosurgical trauma centres of Normandy during the first lockdown. The year before the containment served as control. The primary outcome was the number of patients admitted per week in ICU. We compared the demographic characteristics, TBI mechanisms, CT scan, surgical procedure, and mortality rate.

Results

The incidence of admissions for severe TBI in Normandy decreased by 33% during the containment. The aetiology of TBI significantly changed during the containment: there were less traffic road accidents and more TBI related to alcohol consumption. Patients with severe TBI during the containment had a better prognosis according to the impact score (p=0.04). We observed a significant decrease in the rate of short-term mortality related to severe TBI during the period of lockdown (p=0.02).

Conclusions

Containment related to the COVID-19 pandemic has resulted in a modification of the mechanisms of severe TBI in Normandy, which was associated with a decline in the rate of short-term death in intensive unit care.

How a Pandemic Changes Trauma: Epidemiology and Management of Trauma Admissions in the UK during COVID-19 Lockdown

Introduction:

On June 24 in the United Kingdom, there were 277,989 cases of COVID-19 and 39,369 deaths recorded. The government enforced a complete lockdown on March 23 that resulted in cessation of all elective admissions on 24^th onward, with only acute trauma cases being admitted to hospital. This study aims to characterize the changes in trauma admissions during the first 5-week lockdown period. The hypothesis states that there would be a significant reduction in overall orthopedic trauma admissions, polytrauma, and high-energy outdoor trauma during this COVID-19 period.

Methods:

All trauma admissions over nearly a 5-week period from March 23, 2020, to April 26, 2020, were collated as the “COVID cohort” and compared to the “control” group of patients from the same hospitals 1 year before between March 23, 2019, and April 26, 2019. Spinal admissions and pediatrics were excluded from the study as they were managed in other regional units.

Results:

There was a 56% reduction in trauma admissions during the COVID-19 lockdown (133 vs. 304). A majority of the COVID cohort were admitted with fractures (89 vs. 164, P = 0.017, Chi-square test) from home with low-energy falls. Overall, fewer operations were performed than the year before. However, a greater proportion of admitted patients had a surgical orthopedic intervention rather than admission and nonoperative management.

Conclusions:

There was a reduction in admissions as well as reductions in high energy and occupational injuries. Elderly patients continued to fall at home or in care, sustaining hip fractures. This vulnerable group requires beds, orthogeriatric management followed by surgical intervention and social care. Orthogeriatric services must be maintained to ensure the best clinical outcomes for this group.

COVID-19 Changed the Incidence and the Pattern of Pediatric Traumas: A Single-Centre Study in a Pediatric Emergency Department

The first wave of COVID-19 spread worldwide from March to May 2020. Italy was one of the countries in the world where the lockdown period was most prolonged and restrictive. To date, the impact of prolonged lockdown on pediatric traumas has not fully investigated. This paper aimed to analyze, and compare to 2019, the incidence and the fracture pattern in patients admitted to our pediatric hospital during the total lockdown period. A single-center retrospective study was performed. The data were gathered from the Pediatric Emergency Department (PED) of the Bambino Gesù Children Hospital of Rome (Palidoro). This PED is the pediatric referral center for Rome and the hub for pediatric traumas of the region. Any admission diagnosis for fracture, trauma, sprains and dislocation during the lockdown period (10 March-4 May) were included. The demographic data, diagnosis, type of treatment, fracture segment, bone involvement and time interval between trauma and presentation to the PED were recorded. In 2020, a reduction of total traumas and fractures, compared to 2019 (p < 0.001), occurred (81%). Superior limb and inferior limb fractures decreased in 2020 compared to 2019 (p < 0.05). The identification of pediatric traumas and fractures trend could be useful to reorganize the PED. Epidemiological data from the previous lockdown could be helpful to prepare the healthcare system for new pandemic waves. Moreover, sharing national statistics and correlating those to other countries' protocols, could be helpful to solve problems in case of worldwide emergency situations.

The Effect of Shelter-In-Place on Orthopedic Trauma Volumes in Italy During the COVID-19 Pandemic

BACKGROUND

The COVID-19 outbreak heavily attacked Italy, putting a strain for an extended time on the National healthcare system.  Hospitals fastly rearranged the activity to cope with the crisis. This retrospective comparative study intended to investigate the impact of the lockdown imposed in Italy, in two different periods, during the COVID-19 outbreak on acute orthopedic trauma, in order to identify significant issues for improvement and future preparation.

MATERIALS AND METHODS

We obtained data on total trauma access to a single University hospital DEA (Department of Emergency and Acceptance) in Rome during two periods of the COVID-19 pandemic lockdown in Italy: from March 9th, 2020 to May 4th, 2020(Phase 1), from May 10th, 2020 to June 30th, 2020(Phase 2) and then comparing them with the analogous period in 2019. We recorded demographic data; the characteristics of the lesion, including the anatomical area, fracture, sprain, dislocation, contusion, laceration, whether the lesion site was exposed or closed, where the trauma occurred and polytrauma. We also reported the waiting time in the emergency room and the mode of transport.

RESULT

The study sample was composed of 1655 patients, 894 (54%) males and 761 (46%) females. The overall number of admissions in 2019 (pre-COVID-19 period) was 995; then it was 204 during Phase 1 and increased again to 456 during Phase 2. The average age of the Phase 1 group was 51.9 ± 24.8 years, significantly higher than that of the 2019 group (41.4 ± 25.7) and Phase 2 group (42.2 ± 22.5 years) (p<0.0001). In particular, elderly patients (>=65 years) were the most commonly involved in the Phase 1 group, while in the pre-COVID-19 period and in Phase 2 they were middle-aged adults (15-44 years) (p<0.0001). The injury occurred at home in 66.2% of cases in the Phase 1 group, in 32.3% of cases in the Phase 2 group and in 32.3% of patients in the 2019 group. Concerning the injury type, in all groups, the most frequent injury was a fracture (45.1% in 2019; 62.7% in Phase 1; 50% Phase2) (p<0.0001). The most injured anatomical section during Phase 1 was the upper limb (43.1%), while in the pre-COVID-19 group and in Phase 2 group the most frequent injury location was the lower limb (48.3% and 40.8% respectively).

CONCLUSION

Despite the decrease of overall acute trauma referral rates during the COVID-19 outbreak in Italy, the incidence of fractures in elderly people remained constant, indicating that not all trauma presentations would inevitably decrease during such circumstances.

Effects of COVID-19 pandemic curfew on orthopedic trauma in a tertiary care hospital in Turkey

OBJECTIVE

This study aimed to investigate whether various curfew practices affect trauma prevalence, epidemiological differences among the population admitted to hospital because of trauma, and treatment practices used after trauma.

METHODS

Patients who suffered from fractures or soft-tissue trauma between March 21, 2020, and June 1, 2020, (group pandemic) and during the same period in 2019 (control group) were included in our single-center retrospective study. Each group was also divided into 3 subgroups according to the age of patients (≤ 20 years, 21-64 years, and ≥ 65 years). Data including anatomical region subjected to trauma, place of admission, mechanism of trauma, location of trauma, mode of treatment, type of surgery (if performed), duration of hospitalization (if hospitalized), time elapsed until surgery, and duration of postoperative hospitalization were collected and compared between groups.

RESULTS

A total of 361 patients were admitted to the hospital with new trauma during the pandemic, and 708 patients had been admitted during the same period in 2019. The number of admissions decreased significantly by 50.9% (P < 0.001). The mechanism of trauma that occurred with low energy was significantly increased in the pandemic group (73.9%) compared with the control group (47.6%) (P < 0.001). Similarly, the distribution of trauma throughout the skeletal system, especially in the upper extremity, was significantly increased in the pandemic group (49.9% vs. 30.5%, P < 0.001). However, there was no significant decrease in individuals aged above 65 years (P = 0.115). Similar to the general outlook, the 3 groups differed in terms of the mechanism of trauma, location of trauma, and distribution of the anatomical region subjected to trauma (P < 0.001). Majority of the patients received inpatient treatment in all 3 groups (P < 0.001).

CONCLUSION

The results of this study showed that the pandemic dramatically reduced the number of hospital admissions related to orthopedic trauma. The rate of low energy, upper extremity traumas that occurred indoors increased during the pandemic period compared with that of the previous year. However, the rate of hospital admissions did not differ in the ≥65-year-old subgroup during the pandemic period compared with that of the previous year.

Epidemiology of distal radius fractures in children and adults during the COVID-19 pandemic - a two-center study

Background

Distal radius fractures (DRFs) constitute 15–21% of all fractures. There are no detailed data on the possible changes in the epidemiology and treatment of DRFs in children and adults during the Covid pandemic. The purpose of our study was a comprehensive assessment of the impact of the COVID-19 pandemic on distal radius fractures (DRF) epidemiology, including both children and adults and various fracture fixation methods in two large trauma centers in Poland.

Methods

This study compared the medical data on the treatment of distal radius fractures in Poland in two periods: the period of the COVID-19 pandemic (from March 15 to October 15, 2020) and the corresponding period prior to the pandemic (from March 15 to October 15, 2019). We assessed detailed data from two trauma centers for pediatric and adult patients. Outpatients seeking medical attention at emergency departments and inpatients undergoing surgery at trauma-orthopedic wards were evaluated. We compared epidemiological data, demographic data, treatment type, and hospital stay duration.

Results

The total number of patients hospitalized due to DRF during the pandemic was 180, it was 15.1% lower than that from the pre-COVID-19 pandemic period (212). In the case of adult patients, the total number of those hospitalized during the pandemic decreased significantly (by 22%) from 132 to 103 patients. Analysis of the individual treatment methods revealed that the number of adults who underwent conservative treatment was considerably (by 30.3%) significantly lower in the period of the COVID-19 pandemic, from 119 to 83 patients. Compared to 13 patients from the pre-pandemic period, the number of surgically treated adults statistically increased to 20 patients (by 53.8%). Our analyses showed hospitalizations of surgically treated adults to be shorter by 12.7% during the pandemic, with the corresponding hospitalizations of surgically treated pediatric patients to be shorter by11.5%.

Conclusions

Our study showed a significant impact of the COVID-19 pandemic on the epidemiology and treatment of DRFs in children and adults. We found decreased numbers of pediatric and adult patients with DRFs during the COVID-19 pandemic. The pandemic caused an increase in the number of children and significantly increase adults undergoing surgical treatment for DRFs, a decrease in mean patient age, shorter significantly length of hospital stay, and an increased number of men with DRFs.

Impact of COVID-19 Outbreak on Emergency Visits and Emergency Consultations: A Cross-Sectional Study

Background

This study aimed to determine the effect of the COVID-19 outbreak on emergency department (ED) visits and emergency consultations according to the triage levels indicating the patients' urgency.

Methods

A cross-sectional retrospective study was performed in the ED of a tertiary training and research hospital between 1 April and 31 May 2020 in İstanbul, Turkey. The daily count of emergency visits and the count of the emergency consultations during the study period were recorded. The emergency visits and consultations in the same months of the previous year (1 April-31 May 2019) were included as a control group.

Results

Approximately 50% reduction in ED visits and a 30% reduction in emergency consultations were detected. A significant decrease was detected in all triage levels of visits and emergency consultations (p < 0.001). Within total ED visits, a significant increase was found in the red (4.32% vs. 4.74%) and yellow (21.66% vs. 33.16%) triage levels visit rates, while the green (74.01% vs. 62.1%) level was decreased. Within total emergency consultations, anesthesiology (0.83% vs. 1.56%) and cardiology (3.17% vs. 3.75%) consultation rates increased, neurology (2.22% vs. 1.15%), orthopedics (3.53% vs. 3.01%), and ophthalmology (2.89% vs. 1.57%) consultation rates decreased, internal medicine (2.45% vs. 2.49%), and general surgery (4.46% vs. 4.64%) consultation rates did not change.

Conclusions

During the COVID-19 pandemic, ED visits at all triage levels decreased. While the rate of critical patient visits increased, non-emergency patient visit rates decreased. The total count of consultations decreased, while the total consultation rates increased. The management of the COVID-19 pandemic will be easier by using or developing appropriate triage scores, as well as establishing good interdisciplinary coordination.

Injury patterns of patients with upper limb and hand trauma sustained during the COVID-19 pandemic lockdown in the UK: a retrospective cohort study

This work aimed to identify the lead causes of upper limb injury presenting to a busy hand and major trauma unit during the UK COVID-19 domestic lockdown period, in comparison to a cohort from the same period one year previously. Hand and upper limb injuries presenting to the host organization during a pre-lockdown period (23rd March 2019–11th May 2019) and the formal UK lockdown period (23rd March 2020–11th May 2020) were compared, using data collated from the host institution’s hand surgery database. The UK lockdown period was associated with a 52% fall in the number of patients presenting to the service with hand and upper limb injuries (589 pre-lockdown vs. 284 during lockdown). There was a significant increase in the proportion of injuries due to machinery use during lockdown (38, 6.5% pre-lockdown vs. 33, 11.6% during lockdown, P = 0.009), other etiologies were consistent. The proportion requiring surgical management were similar (n = 272, 46.2% pre-lockdown vs. n = 138, 48.6% during lockdown, P = 0.50). The proportion requiring overnight admission fell (n = 94, 16.0% pre-lockdown vs. 29, 10.2% during lockdown, P = 0.022). COVID-19 related lockdown in the UK resulted in a reduction in the presenting numbers of hand related injuries; however almost half of these patients still required surgery. These data may be of use to other hand surgery centers for resource planning during future lockdown periods, and for injury prevention strategies in the post-COVID-19 world.

St Andrew's COVID-19 surgery safety study: hand trauma

INTRODUCTION

Adaptation is vital to ensure successful healthcare recovery during the COVID-19 pandemic. Hand trauma represents the most common acute emergency department presentation internationally. This study prospectively evaluates the COVID-19 related patient risk, when undergoing management within one of the largest specialist tertiary referral centres in Europe, which rapidly implemented national COVID-19 safety guidelines.

MATERIALS AND METHODS

A prospective cohort study was undertaken in all patients referred to the integrated hand trauma service, during the UK COVID-19 pandemic peak (April-May 2020); all were evaluated for 30-day COVID-19 related death. Random selection was undertaken for patients with hand trauma who either underwent non-operative (control group) or operative (surgery group) management; these groups were prospectively followed-up within a controlled cohort study design and telephoned at 30 days following first intervention (control group) or postoperatively (surgery group).

RESULTS

Of 731 referred patients (566 operations), there were no COVID-19 related deaths. Both groups were matched for sex, age, ethnicity, body mass index, comorbidities, smoking, preoperative/first assessment COVID-19 symptoms, pre- and postoperative/first assessment isolation and positive COVID-19 contact (p > 0.050). There were no differences in high service satisfaction (10/10 compared with 10/10; p = 0.067) and treatment outcome (10/10 compared with 10/10; p = 0.961) scores, postoperative/first assessment symptoms (1%, 1/100 compared with 0.8%, 2/250; p = 1.000) or proportion of positive tests (7.1%, 1/14 compared with 2.2%, 2/92; p = 0.349), between the control (n = 100) and surgery (n = 250) groups.

CONCLUSION

These data support continued and safe service provision and no increased risk to patients who require surgical management. Such findings are vital for healthcare providers when considering service adaptations to reinstate patient treatment.

The impact of COVID-19 on orthopaedic trauma: A retrospective comparative study from a single university hospital in Italy

The COVID-19 outbreak strongly affected Italy, putting a strain on the National healthcare system. Hospitals quickly reorganized the activity to cope with the emergency. This retrospective comparative study aimed to analyze the impact of the lockdown imposed in Italy during the COVID-19 outbreak on acute orthopedic trauma, in order to identify critical issues for improvement and future planning. We collected data on all the trauma admissions to a single University hospital DEA (Department of Emergency and Acceptance) in Rome during the COVID- 19 pandemic lockdown in Italy, comparing them with the corresponding period in 2019. We reported demographic data; the characteristics of the injury, including the anatomical location, fracture, sprain, dislocation, contusion, laceration, whether the injury site was exposed or closed, where the injury occurred, and polytrauma. We also recorded the waiting time in the emergency room and mode of transportation. The study sample was composed of 1199 patients, 636 (53.04%) males and 563 (46.96%) females. The overall number of admissions in 2019 (pre-COVID-19 period) was 995; then it was 204 during COVID-19 outbreak in 2020. The average age of the 2020 group was 51.9 ± 24.8 years, significantly higher than that of the 2019 group (41.4 ± 25.7) (p<0.0001). In particular, elderly patients (≥65 years) were the most commonly involved in the COVID-19 group, while in the pre- COVID-19 period they were middle-aged adults (15-44 years) (p<0.0001). The injury occurred at home in 65.7% of cases in the 2020 group, and in 32.3% of patients in the 2019 group. Concerning the injury type, in both groups, the most common injury was a fracture (45.1% in 2019; 62.7% in 2020) (p<0.0001). The most injured anatomical location during COVID-19 lockdown was the hand (14.2%), while in the pre-COVID- 19 group the most frequent injury type was polytrauma (22.8%). Despite the decrease of overall acute trauma referral rates during the COVID-19 outbreak in Italy, the incidence of fractures in elderly individuals remained stable, indicating that not all trauma presentations would necessarily decrease during such times.

Clinical Analysis of Causes and Countermeasures of Hand Injury During the COVID-19 Outbreak and Work Resumption Period: A Retrospective Study in a Designated Hospital in China

A total of 95 patients with hand injuries were admitted to the orthopedics department within half a year of the COVID-19 outbreak. Data were collected between January 23, 2020 and July 23, 2020. Data such as patients' demographics, type of injury, location, side of lesions, mechanism of injury, injury site, and surgical management were collected and subsequently analyzed. On the one hand, the total number of emergency visits due to hand injury during the COVID-19 outbreak decreased by 37%, compared to the same period in the previous year. On the other hand, work resumption injuries increased by 40%. Injuries within the resumption period occurred predominantly at work (64.7%) and were significantly higher than the same period in 2019 (37.3%) (P < .001). Machine-related injuries were the most frequent injuries seen in our hospital (58.8%). The majority of cases were from cut injuries (82.4%), with fingers being the most common site of these injuries. Simple fractures and dislocations were also reported during the study. Most injuries were classified as either minor or moderate (90%) during the outbreak. However, during the resumption of work, major injuries were more prevalent (40%). The proportion of major injuries this year's work resumption stage (40%) has almost doubled compared to the previous year (21.8%, P = .006). The resumption of work following the COVID-19 outbreak is a time of high-risk for hand injuries. The overall number of patients with hand injuries admitted into our department has decreased compared to the corresponding period last year. However, workplace injuries, particularly machine-related ones, considerably increased during the first six months after the COVID-19 outbreak. As a result, the proportion of major injuries drastically increased. Emergency and surgical health care providers should be aware of this pattern of hand injuries during this untypical time in order to effectively prepare and plan services.

Development of Case Numbers during the COVID-19 Pandemic in a Center of Maximum-Care for Traumatology and Orthopedic Oncology

(1) Background: The COVID-19 pandemic has led to a significant change in the utilization of trauma surgery and tumor orthopedic hospital facilities. (2) Methods: In a monocentric retrospective analysis, the weekly numbers of cases requiring intra-clinical treatment in the first four months of 2020 were compared with those of 2019. Patients' visits to the emergency department and shock room, consultation hours, work-related accidents, case numbers in the normal and intensive care units, ventilation hours, the "Simplified Acute Physiology Score/ Therapeutic Intervention Scoring System" (SAPS/TISS), the average length of stay in hospital, the number of operations and their degree of urgency, as well as deaths, were analyzed in a study based on the data from 7606 outpatient consultations in 2019 and 6755 in 2020, as well as 993 inpatient cases in 2019 and 950 in 2020. (3) Results: There was a significant reduction in the number of treatments per week in the emergency department (261 ± 29 vs. 165 ± 25; p < 0.001) with the same number of shock room treatments and fewer consultation hour contacts (226 ± 29 vs. 119 ± 65; p = 0.012). There were fewer inpatient cases (66 ± 7 vs. 42 ± 11; p = 0.001), resulting in a fall in the days of hospitalization (492 ± 63 vs. 308 ± 78; p < 0.001) and number of operations (73 ± 7 vs. 55 ± 10; p = 0.012), especially elective procedures (20 ± 3 vs. 7 ± 7; p = 0.008). The SAPS/TISS score was lower (1351 ± 1213 vs. 399 ± 281; p = 0.023). Fewer fracture treatments and septic surgeries were performed, while the number of procedures to treat orthopedic malignancies remained constant. (4) Conclusions: During the first phase of the COVID-19 pandemic, we observed a significant reduction in the number of cases treated in orthopedics. While the number of multiple-injured patients was unchanged, fewer patients presented for primary and regular care. Treatment of acute injuries and malignant tumor diseases was not at risk. There was no effect on in-house mortality. We see a potential for the recruitment of medical staff from the outpatient department, operating room, and the ward. In the event of a future second wave, our results may allow for early planning, particularly of the all-important human resources. Reorganization by hospitals and decreased patient numbers in trauma surgery can enable the reallocation of medical staff, equipment, and beds to increase capacity for COVID-19 patients.

Impact of COVID-19 on hand surgery in Italy: A comparison between the Northern and the Southern regions

The aims of this study were to evaluate the impact of the COVID-19 pandemic on emergency and elective hand surgery in four Italian regions that had either a high (Lombardy and Piemonte) or a low (Sicilia and Puglia) COVID-19 case load to discuss problems and to elaborate strategies to improve treatment pathways. A panel of hand surgeons from these different regions compared and discussed data from the centers they work in. The COVID-19 pandemic had an enormous impact on both elective and emergency surgery in Italy, not only in highly affected regions but also – and paradoxically even at a higher extent – in regions with a low COVID-19 case load. A durable and flexible redesign of hand surgery activities should be promoted, while changing and hopefully increasing human resources and enhancing administrative support. Telematics must also be implemented, especially for delivering rehabilitation therapy.

The Impact of the COVID-19 Pandemic on Plastic Surgery Consultations in the Emergency Department

Background:

Stay-at-Home (SAH) orders implemented in the United States to combat COVID-19 had a significant impact on health care delivery for patients with all conditions. In this study, we examined the effect SAH orders had on the Emergency Department (ED) consultation volume, injury patterns, and treatment of patients managed by our plastic surgery service.

Methods:

In Rhode Island, SAH orders were instituted from March 28, 2020, to June 30, 2020. A retrospective chart review of patients presenting to our Level-1 academic medical center was performed. Patient demographics, types of injuries, and need for treatment in the ED or operating room (OR) were collected. Tests of significance were conducted using a comparison group spanning the same time period, in 2019.

Results:

There was a 36% decrease in ED consultations to plastic surgery during SAH orders when compared with those in 2019. No observed differences were noted in patient demographics between time periods. There were significant increases in the proportions of hand injuries secondary to power tools and facial injuries secondary to falls. No observed differences were identified in injury severity and need for either operating-room interventions or ED interventions for patients seen in consultation during SAH orders.

Conclusions:

SAH orders resulted in a decreased volume of plastic surgery consults in the ED but did not alter patient demographics, injury severity, or need for procedural interventions. There was a 2.9% positivity rate for COVID-19 for asymptomatic patients presenting in the ED with primary hand and facial injuries.

Effects of the COVID-19 lockdown on orthopaedic trauma: a multicentre study across Scotland

AIMS

The UK government declared a national lockdown on 23 March 2020 to reduce transmission of COVID-19. This study aims to identify the effect of lockdown on the rates, types, mechanisms, and mortality of musculoskeletal trauma across Scotland.

METHODS

Data for all musculoskeletal trauma requiring operative treatment were collected prospectively from five key orthopaedic units across Scotland during lockdown (23 March 2020 to 28 May 2020). This was compared with data for the same timeframe in 2019 and 2018. Data collected included all cases requiring surgery, injury type, mechanism of injury, and inpatient mortality.

RESULTS

A total of 1,315 patients received operative treatment from 23 March 2020 to 28 May 2020 compared with 1,791 in 2019 and 1,719 in 2018. The numbers of all injury types decreased, but the relative frequency of hip fractures increased (36.3% in 2020 vs 30.2% in 2019, p < 0.0001 and 30.7% in 2018, p < 0.0001). Significant increases were seen in the proportion of DIY-related injuries (3.1% in 2020 vs 1.7% in 2019, p = 0.012 and 1.6% in 2018, p < 0.005) and injuries caused by falls (65.6% in 2020 vs 62.6% in 2019, p = 0.082 and 61.9% in 2018, p = 0.047). Significant decreases were seen in the proportion of road traffic collisions (2.6% in 2020 vs 5.4% in 2019, p < 0.0001 and 4.2% in 2018, p = 0.016), occupational injuries (1.8% in 2020 vs 3.0% in 2019, p = 0.025 and 2.3% in 2018, p = 0.012) and infections (6.8% in 2020 vs 7.8% in 2019, p = 0.268 and 10.3% in 2018, p < 0.012). Cycling injuries increased (78 in 2020 vs 64 in 2019 vs 42 in 2018). A significant increase in the proportion of self-harm injuries was seen (1.7% in 2020 vs 1.1% in 2019, p = 0.185 and 0.5% in 2018, p < 0.0001). Mortality of trauma patients was significantly higher in 2020 (5.0%) than in 2019 (2.8%, p = 0.002) and 2018 (1.8%, p < 0.0001).

CONCLUSION

The UK COVID-19 lockdown has resulted in a marked reduction in musculoskeletal trauma patients undergoing surgery in Scotland. There have been significant changes in types and mechanisms of injury and, concerningly, mortality of trauma patients has risen significantly.Cite this article: Bone Joint Open 2020;1-9:541-548.

Effect of Lockdown in Surgical Emergency Accesses: Experience of a COVID-19 Hospital

BACKGROUND/AIM

SARS-CoV-2 pandemic imposed extraordinary restriction measures and a complete reorganization of the Health System. The aim of the study was to evaluate the impact of COVID-19 on emergency surgical department accesses.

PATIENTS AND METHODS

Patients admitted to surgical emergency departments was retrospectively recorded during the Lockdown (March 11, 2020-May 3, 2020) and compared with the same number of days in 2019 and immediately before Lockdown (January 16, 2020-March 10, 2020). Diagnoses, priority levels, modes of patient's transportation, waiting times and outcomes were analysed.

RESULTS

During the lockdown phase, we ob-served a reduction in the access to emergency surgical departments of 84.45% and 79.78%, com-pared with the Pre-Lockdown2019 and Pre-Lockdown2020 groups, respectively. Patient's transportation, hospitalization and patients discharge with indications to an outpatient visit, waiting and total times exhibited a significant difference during the lockdown (p<0.005).

CONCLUSION

We observed a reduction of surgical emergency accesses during the lockdown. Implementing the use of the regional systems and preventing overcrowding of emergency departments could be beneficial for reducing waiting times and improving the quality of treatments for patients.

The Effects of Lockdown During the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Pandemic on Neurotrauma-Related Hospital Admissions

Background

The response to the global severe acute respiratory syndrome coronavirus 2 pandemic culminated in mandatory isolation throughout the world, with nationwide confinement orders issued to decrease viral spread. These drastic measures were successful in “flattening the curve” and maintaining the previous rate of coronavirus disease 2019 infections and deaths. To date, the effects of the coronavirus disease 2019 pandemic on neurotrauma has not been reported.

Methods

We retrospectively analyzed hospital admissions from Ryder Trauma Center at Jackson Memorial Hospital, during the months of March and April from 2016 to 2020. Specifically, we identified all patients who had cranial neurotrauma consisting of traumatic brain injury and/or skull fractures, as well as spinal neurotrauma consisting of vertebral fractures and/or spinal cord injury. We then performed chart review to determine mechanism of injury and if emergent surgical intervention was required.

Results

Compared with previous years, we saw a significant decline in the number of neurotraumas during the pandemic, with a 62% decline after the lockdown began. The number of emergent neurotrauma surgical cases also significantly decreased by 84% in the month of April. Interestingly, although the number of vehicular traumas decreased by 77%, there was a significant 100% increase in the number of gunshot wounds.

Conclusions

Population seclusion had a direct effect on the frequency of neurotrauma, whereas the change in relative proportion of certain mechanisms may be associated with the psychosocial effects of social distancing and quarantine.

Prolonged social lockdown during COVID-19 pandemic and hip fracture epidemiology

Purpose

To analyse the impact of prolonged mandatory lockdown due to COVID-19 on hip fracture epidemiology.

Methods

Retrospective case-control study of 160 hip fractures operated upon between December 2019 and May 2020. Based on the date of declaration of national lockdown, the cohort was separated into two groups: ‘pre-COVID time’ (PCT), including 86 patients, and ‘COVID time’ (CT), consisting of 74 patients. All CT patients tested negative for SARS-CoV-2. Patients were stratified based on demographic characteristics. Outcome measures were 30-day complications, readmissions and mortality. A logistic regression model was run to evaluate factors associated with mortality.

Results

Age, female/male ratio, body mass index and American Society of Anaesthesia score were similar between both groups (p > 0.05). CT patients had a higher percentage of Charlson ≥ 5 and Rockwood Frailty Index ≥ 5 scores (p < 0.05) as well as lower UCLA and Instrumental Activities of Daily Living scores (p < 0.05). This translated into a higher hemiarthroplasty/total hip arthroplasty ratio during CT (p = 0.04). Thromboembolic disease was higher during CT (p = 0.02). Readmissions (all negative for SARS-CoV-2) were similar between both groups (p = 0.34). Eight (10.8%) casualties were detected in the CT group, whereas no deaths were seen in the control group. Logistic regression showed that frailer (p = 0.006, OR 10.46, 95%CI 8.95–16.1), less active (p = 0.018, OR 2.45, 95%CI 1.45–2.72) and those with a thromboembolic event (p = 0.005, OR 30, 95%CI 11–42) had a higher risk of mortality.

Conclusion

Despite testing negative for SARS-CoV-2, CT patients were less active and frailer than PCT patients, depicting an epidemiological shift that was associated with higher mortality rate.

Hand injuries treated at a hand emergency center during the COVID-19 lockdown

The recent coronavirus outbreak has tested the adaptability, cooperation and organizational capabilities of our healthcare systems. Restrictions were implemented in several countries to reduce virus transmission whilst emergency departments (ED) were overwhelmed and there was shortage of healthcare providers. Given this situation and the consequences of hand injuries, we studied the epidemiology of hand injuries in an accredited FESSH emergency center during the lockdown in France (March 17 to May 10, 2020) due to the coronavirus outbreak. During this period, 1947 patients consulted for a hand injury. We found high percentages of men (63%), open wounds (70%), domestic accidents (88%) and surgical treatment being required (76%). There was a significant decrease in admissions and consultations relative to the same period in 2019. This reference data can help healthcare systems prepare for future outbreaks and similar restrictions.

Were protective procedures against SARS-CoV-2 effective in an orthopaedic and trauma centre during the lockdown period? A retrospective study

Purpose

The SARS-CoV-2 epidemic started in December 2019 in Wuhan. The lockdown was declared on March 16, 2020 in France. Our centre had to adapt daily practices to continue to take care of bone and soft tissue tumours and emergencies. Through this study, we wanted to assess the various procedures implemented during the lockdown period between March 17 and May 10.

Methods

A monocentric retrospective cohort study was conducted in Cochin Hospital (Paris, France). Patients included were those who had surgery during the lockdown period. To take care of COVID-19 positive and negative patients, various procedures have been set up: reverse transcriptase polymerase chain reaction (RT-PCR) tests for all hospitalized patients, a specific unit for COVID-positive patients, a specific surgical room, and use of protective personal equipment.

To allow the effectiveness of the procedures implemented, we evaluated the number of complications attributed to SARS-CoV-2 and the number of patients who became COVID positive during hospitalization.

Results

During the lockdown period, there were 199 procedures of three types of procedures in our centre: 79 traumatology procedures (39.7%), 76 of bone and soft tissues tumours (38.2%), and 44 procedures related to infection (22.1%). We observed 13 complications (6.5%) during hospitalization, and only one patient became COVID-19 positive during the hospitalization.

Conclusion

The COVID-19 epidemic has been a challenge for organization and adaptation to manage all COVID-19 positive and COVID negative. Through this study, we wanted to assess our procedures taken. They had been effective due to the low number of contamination and complications.