Where Have All the Fractures Gone? The Epidemiology of Pediatric Fractures During the COVID-19 Pandemic

Abstract

Background: During the COVID-19 pandemic, public health measures to encourage social distancing have been implemented, including cancellation of school and organized sports. A resulting change in pediatric fracture epidemiology is expected. This study examines the impact of the COVID-19 pandemic on fracture incidence and characteristics. Methods: This is a retrospective cohort study comparing acute fractures presenting to a single level I pediatric trauma hospital during the COVID-19 pandemic with fractures during a prepandemic period at the same institution. The “pandemic” cohort was gathered from March 15 to April 15, 2020 and compared with a “prepandemic” cohort from the same time window in 2018 and 2019. Results: In total, 1745 patients presenting with acute fractures were included. There was a significant decrease in the incidence of fractures presenting to our practice during the pandemic (22.5±9.1/d vs. 9.6±5.1/d, P<0.001). The presenting age for all fractures decreased during the pandemic (7.5±4.3 vs. 9.4±4.4 y, P<0.001) because of decreased fracture burden among adolescents. There were also a decrease in the number of fractures requiring surgery (2.2±1.8/d vs. 0.8±0.8/d, P<0.001). During the pandemic, there was an increase in the proportion of injuries occurring at home (57.8% vs. 32.5%, P<0.001) or on bicycles (18.3% vs. 8.2%, P<0.001), but a decrease in those related to sports (7.2% vs. 26.0%, P<0.001) or playgrounds (5.2% vs. 9.0%, P<0.001). There was no increase in time-to-presentation. Patients with distal radius torus fractures were more likely to receive a velcro splint during the pandemic (44.2% vs. 25.9%, P=0.010). Conclusions: Pediatric fracture volume has decreased 2.5-fold during the COVID-19 pandemic, partially because of cessation of organized sports and decreased playground use. In endemic regions, lower trauma volume may allow redeployment of orthopaedic surgeons and staff to other clinical arenas. Given the rising proportion of bicycling injuries, an emphasis on basic safety precautions could improve public health. An observed increase in the prescription of velcro splints for distal radius fractures highlights an opportunity for simplified patient care during the pandemic. Level of Evidence: Level III.

Reduced Number of Pediatric Orthopedic Trauma Requiring Operative Treatment during COVID-19 Restrictions: A Nationwide Cohort Study

“…We postulate this to be due to implemented restrictions and recommendations in our society. With only 327 COVID-related deaths by mid-June in Finland compared to harder hit countries such as United States, Italy, France, and the United Kingdom (8), the overall reduction in pediatric trauma patients in our study (24%) was relatively lower as compared to United States, for example, where fracture reduction was 58% (7).…”

A look at the global impact of SARS CoV-2 on orthopedic services

“…2 ). Four centers 6 , 20 , 29 , 38 reported the attendance figures for outpatient clinics for both pandemic-era and pre-pandemic time periods, with an overall decrease of 63% being observed (84174/123967, 0.37, CI: 0.24 to 0.51).

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“…Three studies reported the proportion of polytrauma cases seen in the ED for both pre-pandemic and pandemic periods, with a general trend favoring the increased incidence of polytrauma during the COVID-19 era. 6 , 28 , 36 Bram et al. reported that 14.2% of pre-pandemic and 19.3% of pandemic-era ED cases presented with polytrauma.…”

“…reported that 14.2% of pre-pandemic and 19.3% of pandemic-era ED cases presented with polytrauma. 6 Park et al. stated that 18.9% of pre-pandemic and 25.4% of pandemic-era cases presented with polytrauma.…”

Changes in patterns of activity at a tertiary paediatric neurosurgical centre during the first wave of the 2020 pandemic

“…Changes in patterns of paediatric emergency department attendances [2,3], accessing of community care [2] and increased acuity at the time of attendance at hospital [2,4] have all been reported. The epidemiology of specific pathology has also changed, for example, patterns of fractures [5].…”