Epidemiology and incidence of paediatric orthopaedic trauma workload during the COVID-19 pandemic: A multicenter cohort study of 3171 patients

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.

Age-related trends in unintentional injuries among children and adolescents in an urban Danish population 1980-2021. A cohort study of 292,737 children and adolescents

OBJECTIVE

This study describes the age-related trends in unintentional injuries in children and adolescents in an urban population 1980-2021. A retrospective study of all children and adolescents aged 0-17 years treated for unintentional injuries at Odense University Hospital, Denmark 1980-2021.

METHODS

Information about age, gender, place of injury, and diagnoses from the emergency department register. We estimated gender specific annual incidence rates (IRs) in different age groups (0-4, 5-9, 10-14, and 15-17 years) per 1000 population/years. The severity was classified by mild or severe injuries.

RESULTS

Overall, 292,737 unintentionally injured children and adolescents were included. The median age was 10 years and 57.4 % were boys. The overall IR was 241 (CI: 240-242) for boys and 188 (CI: 187-188) for girls per 1000 population/years. In the study period, the overall incidence decreased by 44 % in boys and by 38 % in girls. The overall IR for severe injuries did not change in the study period, whereas the IR of mild injuries decreased significantly in all age groups in both gender. The upper limbs were the most frequently injured in all age groups for both gender, except for children aged 0-4 years, where lesions mostly occurred in the head or neck. In the youngest age groups 0-4 years and 5-9 years wounds were the most common type of lesion, while bruises were the most common type of lesion in the oldest age groups. Fractures accounted for 14.5 % of the lesions with the highest proportions in the 5-9 years and 10-14 years age group.

CONCLUSION

The study provides information, which is useful when coordinating the resources at emergency departments and for planning preventive campaigns targeting different age groups.

Epidemiology and Pattern of Orthopedic Trauma in Children and Adolescents: Implications for Injury Prevention

BACKGROUND

Orthopedic injuries are prevalent in children and can result in hospitalization and damage. The number of accidental injuries among children increases every year, leading to a huge burden on communities and health institutions.

AIM

This study aimed to assess the epidemiological pattern of orthopedic trauma among children and adolescents in Abha, Saudi Arabia.

METHODS

A retrospective record-based study was carried out to investigate the epidemiological pattern of orthopedic trauma among children and adolescents treated at Abha Maternity and Children Hospital in Saudi Arabia, a traumatic center for pediatric patients. The study covered all children and adolescents treated at the hospital for orthopedic trauma. The parents of the children and adolescents were called to get their consent to participate in the study. The following data were extracted from the medical files: personal information, medical history, trauma-related details, management, hospitalization, and complications.

RESULTS

A total of 295 children and adolescents were included. The mean ± standard deviation age was 6.8 ± 3.1 years old (range 1 month to 13 years). Of the patients, 186 (63.1%) were male. The most reported causes of traumas were fall from height (48.1%) and injury while playing (19.7%). The most affected body parts included the forearm (22.4%), head (21.7%), thigh (20%), and leg (10.8%). The vast majority of the children and adolescents (87.1%) had no complications.

CONCLUSION

The current study revealed that pediatric orthopedic injuries are not rare, and there is a higher likelihood of injuries among young male children. Fall from height and play-associated injuries are the most frequent causes.

VOLCON: a randomized controlled trial investigating complications and functional outcome of volar plating vs casting of unstable distal radius fractures in patients older than 65 years

BACKGROUND

Primary aim: to compare complications of operative vs non-operative treatment of unstable distal radius fractures (DRF) fulfilling national clinical guidelines for operative treatment. Secondary aim: to compare the functional outcomes.

MATERIALS AND METHODS

A single-centre randomized controlled trial of unstable DRF. 50 patients: volar locking plate, 2 weeks casting + 3 weeks orthosis. 50 patients: 5 weeks casting.

PRIMARY OUTCOME

complications assessed after 2 and 5 weeks and 6 and 12 months.

SECONDARY OUTCOMES

Quick-DASH, PRWHE, range of motion, grip strength, EQ-5D-3L.

RESULTS

148 patients were screened from November 2019 to March 2021. 48 patients did not want to participate or were unable to participate in the follow-up. 100 patients were randomized and 85 patients were available for full analysis due to there being 4 deaths, 6 withdrawals, 1 wrong inclusion, 1 emigration, 1 refracture, 1 patient with compartment syndrome, and 1 who was advised to undergo surgery after being randomized to non-operative treatment. Median age was 74 years (range 65-92), 81 women/19 men, 42 right/58 left side, 87 retired, 11 smokers, 86 ASA class 1 or 2. Complication rates did not statistical significantly vary between the operative and non-operative group: 20.9% (9/43) vs 16.6% (7/42), p = 0.78 (Fisher's exact test). Complications were driven by sensory disturbances. Four reoperations were performed: two in the non-operative group: carpal tunnel syndrome; two in the operative group: one carpal tunnel syndrome, one protruding screw causing extensor tendon irritation. Mean difference in Quick-DASH varied from 2.3 (95% CI - 3 to 8) pre-injury to 4.2 (- 4 to 12) at 12 months. Quick-DASH and PRWHE were neither statistically nor clinically-relevant different between groups.

CONCLUSIONS

Complication rates after operative and non-operative treatment of DRF were similar. Volar plating did not improve the functional outcome after 5 weeks, 6 months, and 12 months. These findings are in line with recent RCTs and mandate a revision of guidelines towards more conservative treatment.

TAKE HOME MESSAGES

(1) consider non-operative treatment in elderly patients sustaining unstable DRFs; (2) choosing operative treatment in patients older than 65 years should not be the gold standard; (3) however, non-operative treatment still carries a risk for complications.

LEVEL OF EVIDENCE

II. Trial registration Clinicaltrials.gov NCT03716661, registered 23rd Oct 2018; Published protocol PMC6599306.