Epidemic of fractures during a period of snow and ice: has anything changed 33 years on?

Abstract

ObjectivesWe reproduced a frequently cited study that was published in the British Medical Journal (BMJ) in 1981 assessing the extent of ‘snow-and-ice’ fractures during the winter period.SettingThis study aims to provide an insight into how things have changed within the same emergency department (ED) by comparing the findings of the BMJ paper published 33 years ago with the present date.ParticipantsAs per the original study, all patients presenting to the ED with a radiological evidence of fracture during three different 4-day periods were included. The three 4-day periods included 4 days of snow-and-ice conditions and two control 4-day periods when snow and ice was not present; the first was 4 days within the same year, with a similar amount of sunshine hours, and the second was 4 days 1 calendar year later.Primary and secondary outcome measuresTo identify the frequency, distribution and pattern of fractures sustained in snow-and-ice conditions compared to control conditions as well as comparisons with the index study 33 years ago.ResultsA total of 293 patients with fractures were identified. Overall, there was a 2.20 (CI 1.7 to 3.0, p <0.01) increase in risk of fracture during snow-and-ice periods compared to control conditions. There was an increase (p <0.01) of fractures of the arm, forearm and wrist (RR 3.2 (CI 1.4 to 7.6) and 2.9 (CI 1.5 to 5.4) respectively).ConclusionsWhile the relative risk was not of the magnitude 33 years ago, the overall number of patients presenting with a fracture during snow-and-ice conditions remains more than double compared to control conditions. This highlights the need for improved understanding of the impact of increased fracture burden on hospitals and more effective preventative measures.

The impact of lockdown during the COVID-19 pandemic on osteoporotic fragility fractures: an observational study

“…Recent literature has suggested that non-hip fractures as a whole may be more common and costly than hip fractures [13]. Seasonality has been shown for hip and non-hip fragility fractures, with highest incidence during winter months, in many countries [9,[14][15][16][17][18][19][20]. While hip fractures generally require hospital admission, non-hip fractures are generally managed through outpatient Fracture Clinics.…”

Increased fracture incidence in snow and ice conditions; a model for escalation

“…These findings were further supported by the replication of Ralis' original study over three decades later by Al‐Azzani et al 2016. Using the same methods in the same emergency department, they showed that there remains a greater than two fold increase in fractures associated with snow and ice conditions . This suggests that despite some public health preventative measures being implemented in the intervening years (eg, gritting roads and pavements in a timely fashion), little has changed in the pattern and frequency of fractures associated with snow and ice …”

“…Falls on icy surfaces can produce a range of different fractures, often dependent on patient factors (eg, age and bone quality). However, one of the consistent findings, which is most pertinent to management, is that the greatest increase in incidence of fractures is seen in the “walking wounded” category . These are injuries with less impact on patients' mobility and independence, such as distal radius fractures, elbow fractures, hand fractures, and simple foot and ankle fractures.…”

“…2 This suggests that despite some public health preventative measures being implemented in the intervening years (eg, gritting roads and pavements in a timely fashion), little has changed in the pattern and frequency of fractures associated with snow and ice. 2,[5][6][7] Falls on icy surfaces can produce a range of different fractures, often dependent on patient factors (eg, age and bone quality). However, one of the consistent findings, which is most pertinent to management, is that the greatest increase in incidence of fractures is seen in the "walking wounded" category.…”

“…However, one of the consistent findings, which is most pertinent to management, is that the greatest increase in incidence of fractures is seen in the "walking wounded" category. [2][3][4] These are injuries with less impact on patients' mobility and independence, such as distal radius fractures, elbow fractures, hand fractures, and simple foot and ankle fractures. These injuries may be dealt with entirely in the outpatient setting or may sometime include a "day case" admission for surgery.…”