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

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 challenge of estimating the direct and indirect effects of COVID-19 interventions - Toward an integrated economic and epidemiological approach

Decisions on public health measures to contain a pandemic are often based on parameters such as expected disease burden and additional mortality due to the pandemic. Both pandemics and non-pharmaceutical interventions to fight pandemics, however, produce economic, social, and medical costs. The costs are, for example, caused by changes in access to healthcare, social distancing, and restrictions on economic activity. These factors indirectly influence health outcomes in the short- and long-term perspective. In a narrative review based on targeted literature searches, we develop a comprehensive perspective on the concepts available as well as the challenges of estimating the overall disease burden and the direct and indirect effects of COVID-19 interventions from both epidemiological and economic perspectives, particularly during the early part of a pandemic. We review the literature and discuss relevant components that need to be included when estimating the direct and indirect effects of the COVID-19 pandemic. The review presents data sources and different forms of death counts, and discusses empirical findings on direct and indirect effects of the pandemic and interventions on disease burden as well as the distribution of health risks.

[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.

The impact of socioeconomic status on hand injury severity

Socioeconomic status (SES) is an important factor affecting different aspects of human health, including self-care and healthcare service use. The relation between SES and hand injury severity is not well defined; therefore, the present study aimed to investigate the relation between SES and hand injury severity. This cross-sectional descriptive and analytical study included 215 patients with hand injury. Demographic, clinical, and SES-related factors were collected by questionnaire. Injury severity was assessed on Hand Injury Severity Score (HISS). Statistical analysis used the Student t-test, chi-square test and a multinomial regression model to calculate the odds ratio (OR) of each predictive factor. Mean age was 38.02 ± 13.49 years (range, 12-80 years). 73.5% of the participants were men. Patients with low SES were significantly more likely to develop severe hand injury (OR = 5.25 and 9.25 at HISS levels 3 and 4, respectively). In addition, there was a significant association between being born in rural areas and severe (HISS level 3, OR = 2.63) or major (HISS level 4, OR = 2.63) hand injury. Also, major (HISS level 4) hand injuries were significantly more prevalent in patients living in rural areas (OR = 4.23) and those injured in road accidents (OR = 1.98) or practicing sports (OR = 3.51). The study concluded that patients with low SES were 5-10-fold more likely to suffer from severe and major hand injuries, and thus provided valuable information for Iranian policymakers to take preventive measures for hand injuries. It is recommended to improve postoperative care in patients with low SES who underwent hand surgery, take the necessary measures to decrease the incidence of road accident injuries, facilitate early referral of patients with hand injury to trauma centers, and improve postoperative follow-up until full recovery. LEVEL OF EVIDENCE: III.

Changes in acute and trauma hand surgery in the first Covid-19 lockdown in a German trauma center: a retrospective analysis of 338 cases

INTRODUCTION

Although Covid-19 and especially lockdown periods have affected our everyday live, its impact on hand traumatology is under investigated.

MATERIALS AND METHODS

We retrospectively analyzed all patients presenting at a FESSH accredited HTRC and level 1 trauma center in Germany during the Covid-19 lockdown period and an equivalent timeframe in 2019 regarding incidence of hand trauma, injury mechanism, type of injury and hand surgeries.

RESULTS

338 patients presented at our department with acute hand injuries. A significant reduction of work-related accidents was found during lockdown contrary to an increase of do-it-yourself related trauma. Although the incidence of hand trauma decreased during lockdown by 18%, the rate of hand surgery increased in absolute and relative numbers.

CONCLUSIONS

Although Covid-19 has negatively impacting elective and semi-elective surgeries, acute hand surgery has gained in importance represented by a shift from work related to do-it-yourself trauma and an increased rate of surgical treatment.

LEVEL OF EVIDENCE

IV (therapeutic).

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.

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.