Pediatric traumatology in "green zone" during Covid-19 lockdown: A single-center study

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.

Impact of social distancing on traumatic injury incidence during the COVID-19 pandemic: A study using nationwide data from South Korea from 2018 to 2020

BACKGROUND

COVID-19 spread rapidly in 2020. To decrease its transmission rate, governments worldwide implemented social distancing. It has transformed people's physical and social activities. Such changes, differently influenced by age, might affect the incidence of traumatic injury.

HYPOTHESIS

The impact of social distancing on traumatic injuries can influence differently by age.

PATIENTS AND METHODS

Nationwide randomized stratified sampling data (2018 to 2020, 1 million people per year) from Korean National Health Insurance Sharing Service were used. In this period, 364,690 patients with traumatic injuries were analyzed. People were grouped by age into 0-4, 5-19, 20-64, and≥65years. The incidence of traumatic injuries was compared between periods of social distancing and no social distancing. Social distancing levels, injured body parts, injury types, hospitalization rate, total medical cost per patient, weather, temperature, and holidays were also included for detailed analysis.

RESULTS

Only the 5-19 age group showed the significant interaction of social distancing and traumatic injury. In this group, as the social distancing level increased, the injury incidence decreased especially during the spring and autumn semesters. However, the proportion of injuries requiring hospitalization and total medical cost per patient increased.

DISCUSSION

Social distancing significantly affects the incidence of traumatic injuries for schooler (5-19years). Considering that the incidence changed during these semesters, the restriction of school attendance, due to social distancing, may have caused the decrease. Reduced trauma in this group seems to be related to decrease of mild trauma, considering the hospitalization rate and total medical costs.

LEVEL OF EVIDENCE

III, retrospective cohort study.

Influence of COVID-19 pandemic on hospitalisations at a paediatric traumatology department during 2020: a single-centre observational study and comprehensive literature review

PURPOSE

The study investigates changes in the injury characteristics of hospitalised children in a paediatric trauma centre during the COVID-19 pandemic.

METHODS

Data from injured children from the pre-pandemic year 2019 were compared to the pandemic year 2020 using Pearson's chi-squared test and the Mann-Whitney U test. The period of highly restrictive regulations (HRP) was evaluated separately. A comprehensive literature review with defined search terms resulted in a descriptive data synthesis.

RESULTS

Data from 865 patients indicated reductions in admissions of 5.6% and 54.4% during the HRP. In 2020, the hospitalisation time was longer (2.2 ± 2.7 days in 2019 vs. 2.4 ± 2.6 in 2020, p = 0.045); the proportions of wounds requiring surgical therapy (p = 0.008) and of observational treatments, primarily for mild brain injuries (p = 0.046), were higher; and conservative treatments, primarily for contusions, were lower (p = 0.005). There were no significant changes in age, location of lesions, or frequency of surgical therapy; nor were there differences in the HRP, except for fewer injuries in school and kindergarten (p < 0.001). The literature review summarises the main results of 79 studies.

CONCLUSION

Limited resources did not alter the indications for surgical therapy. Further studies should examine whether the more common injuries sustained at home were caused by excessive work/childcare demands on parents. Reduced inpatient conservative treatment implies that hospital resources possibly were overused previously. The literature offers answers to many detailed questions regarding childhood injuries during a pandemic and more efficient safe treatment. Registration Ethical committee of RWTH Aachen University EK 22-320; Center for Translational & Clinical Research RWTH Aachen University (CTC-A) 21-430.

The Effects of the COVID-19 Pandemic on the Pattern of Fractures in Taif City, Saudi Arabia

BACKGROUND

 The COVID-19 pandemic forced the world to take restricted orders to control the spread of SARS-CoV-2 by limiting and controlling people's movement inside their countries. According to previous studies, the shutdown and quarantine affected orthopedic trauma presentations and patterns in many countries. This study aimed to show the change in the pattern of fractures in Taif City, Saudi Arabia, during the curfew period during the COVID-19 pandemic in 2020 and compare it with the same period in 2019.

METHODS

 A retrospective study of all patients with fractures who came to the emergency room and were treated by the orthopedic department at Alhada Armed Forces Hospital, King Abdulaziz Specialist Hospital, and King Faisal Medical Complex, Taif City. During partial and total lockdowns between March 23 and June 21, 2020, Data was collected from this period during September 2023. Demographics, fracture type and site, mechanism of injury, length of admission, if admitted, and the management plan were documented. These fracture cases were compared with those within the same period of March-June from the previous year. All statistical analysis was done using two-tailed tests.

RESULTS

 There was a decrease in the number of fractures at the time of quarantine, with 69 cases in the three months of curfew in 2020, compared to 184 cases in the same three months in 2019. There was a significant difference in the anatomical site of fractures between the two years, with decreased radius/ulna fractures (P= 0.035) and foot fractures (P=0.010). Most fractures during the lockdown were due to home accidents, with a significant decrease in motor vehicle accidents (P=0.009).

CONCLUSION

 The pattern of fractures in Taif City was affected by the movement restriction during the COVID-19 pandemic. The number of fractures decreased by 62.5% during the quarantine compared with the pre-pandemic period. A significant decrease was noted in the number of hospitalized patients (33%) during the COVID-19 lockdown compared to 65.8% in the pre-pandemic period.

Kids gone wild - Alcohol use and patient characteristics in pediatric trauma during the coronavirus disease 2019 pandemic

Importance

Reported coronavirus disease 2019 (COVID-19) pandemic effects on pediatric trauma have been variable.

Objective

We investigated the characteristics of pediatric trauma including alcohol use during the pandemic at our urban trauma center.

Methods

The trauma database of our adult level 1 trauma center was queried for all pediatric (age ≤ 18 years) patients presenting between March 1, 2020, and October 30, 2020. Data from 2017 to 2019 served as a control. Variables analyzed included demographics, mechanisms, injury severity, hospitalization characteristics, and positive blood alcohol.

Results

Pandemic pediatric trauma volumes increased by 67.5% (330/year vs. 197/year). Pandemic patients were younger (median age 13 vs. 14 years, P = 0.011), but similar in gender, ethnicity, severity, hospital length of stay, mortality, and rates of penetrating injury. Falls doubled (79/year vs. 34/year) and shifted away from high falls >6 meters (0% vs. 7.9%) to moderate falls 1-6 meters (58.2% vs. 51.5%) (P = 0.028). Transportation injury rates were similar however mechanisms shifted from motor vehicle crashes (-13.5%) towards recreational vehicles including motorcycles (+2.1%), all-terrain vehicles (+8.6%), and bicycles (+3.8%) (P = 0.018). Pediatric-positive blood alcohol was significantly higher (11.2% vs. 5.1%, P < 0.001), especially for ages 14-18 years (21.7% vs. 9.5%, P < 0.001).

Interpretation

Pediatric trauma volumes during the COVID-19 pandemic increased. Pandemic patients had more recreational vehicle injuries and higher rates of positive blood alcohol. This suggests an increased need for alcohol assessment and targeted interventions in the pediatric population during pandemics or periods of school closures.

The Effect of the COVID-19 Pandemic on Early Adolescent Fractures in the Republic of Korea

Background and Objectives: Restrictions on daily activities to slow down the propagation of COVID-19 have changed the epidemiological pattern of pediatric fractures in many countries. However, the effect of the pandemic on pediatric fractures has not been fully studied. In this study, we investigated the impact of COVID-19 on early adolescent fractures in Korea. Materials and methods: We conducted a retrospective follow-up on a nationwide cohort of Korean early adolescents born between 2006 and 2009. The prevalence and incidence of pediatric fractures and the frequency of surgical treatment were compared between two different eras. Results: The prevalence and incidence of fractures during the pandemic have both shown a significant decrease: prevalence reduced from 34,626 to 24,789 (p < 0.001), while incidence decreased from 29,804 to 18,898 (p < 0.001). Considering sex, the shift in fracture prevalence was statistically significant (p = 0.020), whereas the incidence was not (p = 0.862). The decline in both fracture prevalence and incidence exhibited significant variation across birth year groups (prevalence, p < 0.001; incidence, p < 0.001), with a more pronounced reduction observed in the older age groups. While the proportion of patients who required surgeries has increased, the mean frequency of surgical treatment per patient remained at a similar level (by prevalence, p = 0.181; by incidence, p = 0.735). The decline in both fracture prevalence and incidence has shown significant variation in relation to fracture sites (prevalence, p < 0.001; incidence, p < 0.001), with a decrease in distal limb fractures and an increase in forearm and axial body fractures. Conclusions: The pediatric fracture pattern in Korea has been notably influenced by the COVID-19 pandemic, warranting further investigation into causal factors. Our findings should help predict epidemiology in the post-pandemic period and thus aid policymaking and patient management.

Epidemiology of pediatric trauma and fractures during and beyond the COVID-19 pandemic

PURPOSE

Previous literature has shown decreases in pediatric trauma during the COVID-19 outbreak, but few have analyzed beyond the peak of the pandemic. This study assesses the epidemiology of pediatric trauma cases in a high-volume teaching hospital in New York City before, during, and after the height of the COVID-19 pandemic.

METHODS

Institutional data on pediatric trauma orthopedic cases from January 1, 2018 to November 30, 2021 were extracted. The following time frames were studied: (1) April 1-June 22 in 2018 and 2019 (pre-pandemic), (2) April 1-June 22, 2020 (peak pandemic), and (3) April 1-June 22, 2021 (post-peak pandemic). Inferential statistics were used to compare patient and trauma characteristics.

RESULTS

Compared to the pre-pandemic cohort (n = 6770), the peak pandemic cohort (n = 828) had a greater proportion of fractures (p < 0.01) and had a significantly decreased overall traumas per week rate (p < 0.01) and fractures per week rate (p < 0.01). These decreased trauma (p < 0.01) and fracture rates (p < 0.01) persisted for the post-peak pandemic cohort (n = 2509). Spatial analysis identified zip code clusters throughout New York City with higher rates of emergency department presentation during the peak pandemic compared to pre-pandemic, and these areas aligned with lower-income neighborhoods.

CONCLUSION

During the peak of the pandemic, overall trauma and fracture volumes decreased, the types of prevalent injuries changed, and neighborhoods of different economic resources were variably impacted. These trends have mostly persisted for 12 months post-peak pandemic. This longitudinal analysis helps inform and improve long-term critical care and public health resource allocation for the future.

LEVEL OF EVIDENCE

Level III.

New Injury Patterns in Pediatric Supracondylar Fractures During COVID-19: Beds Are the New Monkey Bars

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic drastically altered children's activity patterns. Our goal was to investigate how COVID-19 affected demographics, injury characteristics, treatment patterns, follow-up, and outcomes in pediatric supracondylar humerus (SCH) fractures.

METHODS

This was an Institutional Review Board-approved retrospective analysis of patients undergoing surgery for a SCH fracture from May to November 2019 (pre-COVID-19) and from May to November 2020 (during COVID-19) at 2 tertiary children's hospitals. Demographic information, injury characteristics, hospital course, and follow-up data were collected and compared.

RESULTS

SCH fractures decreased by >50% from 2019 (149) to 2020 (72). Children in the 2020 cohort were younger (mean 5.2 y old) compared with 2019 (6.0 y old) ( P =0.019). Mechanism of injury was significantly different in 2020 ( P <0.001), as the proportion of trampoline and furniture fractures increased from 8% and 17% to 15% and 33%, respectively. The proportion of playground and monkey bar fractures decreased from 20% and 17% to 3% and 4%, respectively. Distribution of Gartland type and neurovascular injury rates were similar in 2019 and 2020 ( P =0.411 and 0.538). Time from emergency department admission to the operating room and duration of hospital admission were both unchanged from 2019 to 2020 ( P =0.864 and 0.363). The duration of postoperative follow-up in 2019 was 94.5 days compared with 72.8 days in 2020 ( P =0.122), as more pandemic patients were lost to follow up (22.5% vs. 35.2%, P =0.049).

CONCLUSIONS

The demographics, mechanism of injury, and follow-up practices of pediatric SCH fractures changed significantly during the pandemic, likely because of school closures and lock-downs changing activity patterns. Different mechanisms of injury affected younger patients and reflected the new ways children played. Trampoline-related and furniture-related injuries overtook the classic playground falls as primary mechanism of injury. Despite the need for COVID-19 testing, there was no delay in time to the operating room. Hospitalization duration did not change, yet postoperative follow-up was shorter, and more patients were lost to follow up. Despite these stressors, outcomes remained excellent in most children.

LEVEL OF EVIDENCE

Level III-Retrospective comparative study.

[How was spinal surgery activity maintained during the COVID-19 pandemic? Results of a French multicenter observational study]

Introduction

La Société française de chirurgie rachidienne (SFCR) a des recommandations pendant la pandémie COVID. L’objectif de ce travail est de rapporter l’organisation et l’activité en chirurgie rachidienne pendant le premier mois de confinement de 6 centres en France. L’objectif secondaire est de contrôler l’adéquation de nos pratiques avec les recommandations de la SFCR.

Matériel et méthode

Il s’agit d’une étude observationnelle multicentrique prospective entre le 16 mars et le 16 avril 2020 rapportant l’activité chirurgicale rachidienne dans chaque institution, ainsi que les modifications organisationnelles appliquées. L’activité chirurgicale était comparée à celle de la même période en 2019 dans chaque centre et évaluée en fonction des recommandations de la SCFR afin de contrôler l’adéquation de nos pratiques en période de pandémie.

Résultats

Pendant le pic de l’épidémie 246 patients dont 6 patients COVID+ ont été pris en charge chirurgicalement. Les baisses d’activité les plus importantes étaient retrouvées à Strasbourg (−81,5 %) et à Paris (−65 %), régions dans lesquelles la situation sanitaire était la plus critique, mais également à Bordeaux (−75 %) malgré une circulation virale moins importante. Un fonctionnement de 20 à 50 % des capacités normales des salles opératoires était noté. La diminution importante des procédures pour rachis dégénératif ou déformations était en adéquation avec les recommandations de la SFCR.

Conclusion

Le maintien d’une activité chirurgicale rachidienne est possible et souhaitable même en période de crise sanitaire. Les indications doivent être réfléchies selon les critères d’urgences élaborés par les sociétés savantes et adaptées à l’évolution sanitaire et aux possibilités techniques de prise en charge par centre.

Niveau de preuve

IV.

How was spinal surgery activity maintained during the COVID-19 pandemic? Results of a French multicenter observational study

INTRODUCTION

The French Society of Spinal Surgery (SFCR) offered guidelines during the COVID pandemic. The objective of this work was to report the organization and activity in spinal surgery during the first month of confinement across 6 centers in France. The secondary objective was to monitor the adequacy of our practices within the SFCR guidelines.

MATERIAL AND METHODS

This prospective multicenter observational study reported spinal surgery activity in each institution from March 16 to April 16, 2020, as well as the organizational changes applied. Surgical activity was compared to that of the same period in 2019 in each center and evaluated according to the SFCR guidelines, in order to control the adequacy of our practices during a pandemic period.

RESULTS

During the peak of the epidemic, 246 patients including 6 COVID-positive patients were treated surgically. The most significant drops in activity were found in Strasbourg (-81.5%) and Paris (-65%), regions in which the health situation was the most critical, but also in Bordeaux (-75%) despite less viral circulation. Operating rooms functioned at 20 to 50% of their normal capacity. There was a significant reduction in procedures for degenerative spine conditions or deformities, in line with the SFCR guidelines.

CONCLUSION

Maintaining spinal surgery is possible and desirable, even in times of health crisis. The indications must be considered according to the emergency criteria developed by learned societies and adapted to health developments and to the technical possibilities of treatment, by center.

LEVEL OF PROOF

IV.

[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.

Epidemiologic Changes in Pediatric Fractures Presenting to Emergency Departments During the COVID-19 Pandemic

BACKGROUND

Fractures are a common pediatric injury. The coronavirus disease 2019 (COVID-19) pandemic resulted in significant changes in daily life that could impact the incidence of pediatric fractures. The purpose of this study was to compare the incidence of pediatric fractures in the United States during the COVID-19 pandemic to previous seasonally adjusted fracture incidence rates using the National Electronic Injury Surveillance System (NEISS) database and the American Community Survey (ACS).

METHODS

The NEISS database was queried from 2016 to 2020 for fractures occurring in pediatric (0 to 17 y) patients. ACS population data allowed for the estimation of fracture incidence per 1000 person-years. Using a quasiexperimental interrupted time series design, Poisson regression models were constructed to test the overall and differential impact of COVID-19 on monthly fracture rate by age, sex, fracture site, injury location, and disposition.

RESULTS

Our sample consisted of 121,803 cases (mean age 9.6±4.6 y, 36.1% female) representing 2,959,421±372,337 fractures nationally. We identified a stable 27% decrease in fractures per month after February 2020 [risk difference (RD) per 1000 youth years=-2.3; 95% confidence interval: -2.98, -1.57]). We found significant effect modification by age, fracture site and injury location ( P <0.05). The fracture incidence among children 5 years or older significantly decreased, as well as the incidence of fractures at school [RD=-0.96 (-1.09, -0.84)] and during sports [risk difference=-1.55 (-1.77, -1.32)]. There was also a trend toward a reduction in upper extremity fractures and fractures requiring admission.

CONCLUSION

A nationally representative injury database demonstrated a 27% decline in monthly pediatric fractures during the COVID-19 pandemic that persisted into the latter half of 2020. These trends appeared most attributable to a reduction in fractures discharged home and upper extremity fractures among older children sustained at school and in sports. Our findings provide unique insight into the epidemiology of pediatric fractures and demonstrate a baseline need for musculoskeletal care among young children even in the setting of a national shutdown.

LEVEL OF EVIDENCE

Level II-retrospective prognostic study.

Epidemiology of pediatric fractures before versus during the coronavirus disease 2019 pandemic

Several studies have reported changes in the prevalence of childhood fractures between the prepandemic and coronavirus disease 2019 pandemic periods considering the overall decrease in activity during the latter. This review aimed to organize and summarize the global trends in pediatric fracture incidence. Our findings should help predict fracture patterns in the postpandemic period by identifying changes in the past and present, thus aiding patient management.

Orthopaedic, trauma surgery, and Covid-2019 pandemic: clinical panorama and future prospective in Europe

Purpose

This study investigated the impact of the Covid-19 pandemic in Europe on consultations, surgeries, and traumas in the field of orthopaedic and trauma surgery. Strategies to resume the clinical activities were also discussed.

Methods

This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the 2020 PRISMA statement. All the comparative studies reporting data on the impact of Covid-19 in the field of orthopaedic and trauma surgery in Europe were accessed. Only comparative clinical studies which investigated the year 2020 versus 2019 were eligible.

Results

57 clinical investigations were included in the present study. Eight studies reported a reduction of the orthopaedic consultations, which decreased between 20.9 and 90.1%. Seven studies reported the number of emergency and trauma consultations, which were decreased between 37.7 and 74.2%. Fifteen studies reported information with regard to the reasons for orthopaedic and trauma admissions. The number of polytraumas decreased between 5.6 and 77.1%, fractures between 3.9 and 63.1%. Traffic accidents admissions dropped by up to 88.9%, and sports-related injuries dropped in a range of 59.3% to 100%. The overall reduction of the surgical interventions ranged from 5.4 to 88.8%.

Conclusion

The overall trend of consultations, surgeries, and rate of traumas and fragility fractures appear to decrease during the 2020 European COVID pandemic compared to the pre-pandemic era. Given the heterogeneities in the clinical evidence, results from the present study should be considered carefully.

Level of evidence

Level IV, systematic review.

Decreases in pediatric fractures during the COVID-19 pandemic - a nationwide epidemiological cohort study

The COVID-19 pandemic led to fundamental changes in daily routines of children. Our aim was to evaluate the incidence and characteristics of fractures among Israeli children during 2020 compared with 2015-2019. Demographic, clinical data, and incidence rates of fractures in individuals aged < 18 years were derived from the electronic database of Meuhedet Health Services, which provides healthcare services to 1.2 million people in Israel. We further subdivided the year to five periods according to government regulations of lockdown and isolation at each period. Fracture sites were determined according to ICD9 definitions. During 2020, 10,701 fractures occurred compared with 12,574 ± 599 fractures per year during 2015-2019 (p-value < 0.001). Fracture rates were lower during all periods in 2020. The largest decline was observed during the first lockdown for both boys (56% decline, 95% confidence interval [CI] 52-60%) and girls (47% decline CI 41-53%). While the fracture rate declined for most age groups, the largest decline was recorded for the age group 11-14 years, with significant reduction rates of 66% (CI 59-71%) for boys and 65% (CI 54-73%) for girls. The most prominent declines were of fractures of the hand bones of both boys and girls (64% and 59%, respectively). Conclusions: Our data showed a significant decrease in fracture rate in 2020 compared to the previous 5 years, as well as differences between periods within that year. What is New: •The COVID-19 pandemic led to fundamental change in daily routines of children with significant decrease in school attendance and sport activities. •Consequent to these public health measures, the incidence rate of pediatric fractures decreased significantly. What is New: •This study demonstrates declines in fracture rates during lockdown periods, with only partial reversing of the trends between the lockdown periods. •The most pronounced decline was observed during the first lockdown period. •The decline was most prominent in children aged 11-14 years; there was no significant change in fracture incidence of children aged <3 years.

Epidemiology of Paediatric Orthopaedic Trauma, Before, During, and After the Outbreak of COVID-19 Pandemic: An Observational Study From a Tertiary Referral Center in Wales

Introduction The outbreak of coronavirus disease 2019 (COVID-19) and the resultant lockdown has had a great impact on global healthcare. This observational study aimed to analyse the consequences of national lockdown on the epidemiology of significant paediatric orthopaedic trauma, presenting to a tertiary referral centre in Wales, during the COVID-19 pandemic in the United Kingdom. Methods Paediatric patients presenting with orthopaedic trauma, from March 2019 to July 2019 (baseline period), March 2020 to July 2020 (lockdown period), and March 2021 to July 2021 (post lockdown period), were identified and compared. Those aged less than 16 years, presenting with a significant orthopaedic injury, defined here for the study as, those requiring either manipulation under anaesthesia or, surgical intervention were included in this study. Results Mean age of children with significant orthopaedic injuries during the lockdown dropped significantly to 6.52 years in comparison to those during the baseline period (7.9 years), and post lockdown period (8.85 years). The incidence of outdoor injuries plummeted significantly from 64.71% in the baseline period, to 41.27% during the lockdown period, but rose to 80.65% in the post lockdown period. There was a 48% reduction in the number of children who required intervention in operating theatre during the lockdown period, in comparison to the other two study periods. Conclusion Our study reports a significant decrease in the incidence of paediatric orthopaedic trauma needing intervention in operating theatre during the lockdown period, with a significant rise in the incidence of domestic injuries, and relatively younger children sustaining these injuries. A public information campaign could help reduce the incidence of such domestic accidents during future lockdowns. We recommend improving awareness among parents, creating a safe indoor as well as outdoor environment to help reduce the incidence of fractures in the paediatric population. This will subsequently help in reducing the financial burden on an already stretched healthcare system.