Impact of COVID-19 Pandemic on Orthopaedic Trauma Volumes: a Multi-Centre Perspective From the State of Telangana

Abstract

Background The COVID-19 outbreak reached pandemic proportions in March 2020, and the government of India declared a nationwide lockdown on 24th March, 2020. All vehicular movement, construction work, industries, national highways, etc. remained closed during lockdown. The aim of this study was to assess the impact of lockdown on the case load and epidemiology of orthopaedic trauma cases in the state of Telangana. Methods This study was a multi-centre, retrospective observational study. Data were collected from 8 teaching hospitals, 8 corporate hospitals, 1 dedicated industrial trauma, and hand injury center and 56 consultants with individual practice. Data were collected in two groups, pre-lockdown period (23rd Feb to 24th March) and lockdown period (25th march to 25th April). Patient demographics, type of injury, and cause of injury were collected. This was done using an online survey form and retrieval of case data from health records. Results There was a significant decrease in total trauma numbers during lockdown by 1266 cases (pre-lockdown n = 2020 and lockdown n = 754), amounting to a decrease by 62.7% ( p < 0.01). RTA was the leading cause of trauma in all age groups except in elderly and we found a reduction of 77.9% cases during lockdown ( n = 1343 vs. n = 298). The numbers of fragility fractures in elderly were unaffected due to lockdown. Conclusion RTA was the major cause of injuries in young adults and adults. Though they cannot be eliminated, RTA numbers can be reduced by strict implementation of traffic rules and better road infrastructure. Lockdown had no effect on incidence of fragility fractures in elderly. With changes in life style and more people working from home there may be a reduction in overall injuries in future.

Impact of COVID‐19‐related social restrictions on orthopaedic trauma in a level 1 trauma centre in Sydney: the first wave

“…A tertiary centre in London that did not alter its threshold for surgery based on this recommendation noted a decrease in surgical cases of one‐third compared to pre‐pandemic, suggesting that the primary driver of decreased procedures was decreased referral volume, rather than local protocol 13 . Similar decreases in trauma referrals have been recognized in centres in the USA, 14 Spain 15 and India 16 …”

“…13 Similar decreases in trauma referrals have been recognized in centres in the USA, 14 Spain 15 and India. 16 Physical distancing requirements and mandatory shutdown of businesses, workplaces and gatherings have transformed daily activities. The Citimapper Mobility Index estimates the movement of people within Sydney decreased by up to 84% in March, as fewer people utilized public transport or drove to their places of work.…”

Epidemiological pattern of orthopaedic fracture during the COVID-19 pandemic: A systematic review and meta-analysis

“…Overall, the number of fractures decreased sharply in all 13 , 17 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 but one 32 of the included studies. Although the total number of fractures was reduced by 43% (35–50%) during the pandemic, we found that the proportion hand fractures was lower (significant), the proportion of femur fractures was higher (borderline significance), whereas the proportion of fractures at other locations was relatively constant.…”

“…Since the beginning of COVID-19 epidemic, the incidence of orthopaedic trauma admission has declined substantially given the widespread implementation of self-isolation, quarantine, lockdown, and travel restrictions. 13 , 14 , 15 , 16 People are urged to stay at home and only seek medical services if they experience a medical emergency. Reduction on public mobility and outdoor activities contributed to the decrease in motor vehicle accidents, sport-related traumas, and work-related traumas.…”

Thirty-day mortality of patients with hip fracture during COVID-19 pandemic and pre-pandemic periods: A systematic review and meta-analysis

“…Hip fracture is a surgical emergency. Despite mandatory lockdown during COVID-19 pandemic, hip fracture incidence has remained unaltered[ 2 - 5 ].…”