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

Abstract

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.

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

“…Our results show a significant decrease in injuries sustained during the HRP in public facilities. In the literature, during the pandemic, the majority of studies reported an increase in the proportion of injuries occurring in the domestic environment [ 4 , 8 , 23 , 26 , 41 – 44 ], whereas the incidence of outdoor injuries acquired in public areas or in sports clubs significantly decreased [ 8 , 23 , 26 , 42 , 44 , 45 ].…”

“…It might be suggested that the nationwide lockdown and the cancellation of sports and other hobbies markedly decreased injuries among children aged 13–17 years, while the decrease was lower among younger children, as the cancellation of sports and hobbies did not affect patients in this age group as much as it did adolescents [ 13 ]. However, many studies have found a significantly younger age of patients requiring admission or surgery during the lockdown [ 2 , 3 , 5 , 7 – 9 , 12 , 20 , 25 , 26 , 29 , 31 , 34 , 38 , 39 , 42 , 46 , 48 – 50 ]. Although not significantly, the mean age of our patients was also lower during the pandemic.…”

Differences in Trampoline-Related Knee Injuries Between Children and Adults: A Cross-Sectional Study

“…It can be assumed that the COVID-19 pandemic contributed to this peak. 28 With restrictions on social gatherings, the closure of gyms and playgrounds, and limited outdoor options, many people turned to home-based activities for entertainment and exercise. 7 Trampolines became an increasingly popular choice when people were encouraged to stay home to reduce the spread of the virus.…”

“…7 Trampolines became an increasingly popular choice when people were encouraged to stay home to reduce the spread of the virus. 28 This led to reduced opportunities for physical activity, particularly for children and adolescents. Trampolines offered an attractive alternative that allowed individuals to engage in active play and exercise within the confines of their homes.…”

“…The demand for trampolines surged and resulted in a significant increase in trampoline ownership and an influx of new jumpers who were not accustomed to trampolines or were not properly trained, potentially leading to increased injuries. 28 Moreover, extended periods of lockdowns and reduced physical activities resulted in a decline in overall physical fitness and conditioning. 21 When individuals, particularly children, suddenly engage in vigorous physical activities like jumping on a trampoline without adequate preparation, their bodies may be more susceptible to injuries.…”