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Three Years of COVID-19 on Orthopaedic Trauma; Are We Going Back to Normality?
Vittorio Candela1, Riccardo Proietti1,2, Giuseppe Polizzotti1,2
1Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Sapienza University of Rome, 00185 Rome, Italy.
Insights
The COVID-19 pandemic significantly impacted trauma surgery, reducing sports and high-energy injuries in 2020. While a return to normality is observed, elderly fractures from falls remain constant.
Area of Science:
- Orthopaedic Trauma Surgery
- Public Health Impact of Pandemics
- Epidemiology of Traumatic Injuries
Background:
- The COVID-19 pandemic led to widespread restrictions, significantly affecting healthcare services, including trauma surgery.
- Understanding the impact on trauma centers is crucial for resource allocation and patient care planning.
Purpose of the Study:
- To evaluate the activity of a suburban trauma center during the initial COVID-19 lockdown period (March-April 2020).
- To compare trauma case data with pre-pandemic (2019) and post-lockdown (2022) periods.
- To assess the progressive return to pre-pandemic levels of trauma activity.
Main Methods:
- Retrospective analysis of all patients over 18 managed in the Trauma Unit.
- Comparison of data from March 8-April 8, 2020, with the same periods in 2019 and 2022.
- Categorization of diagnoses and injury mechanisms.
Main Results:
- A significant decrease in overall trauma cases was observed in 2020 compared to 2019 and 2022.
- Injuries from sports and high-energy trauma (e.g., traffic accidents) drastically reduced in 2020, with partial recovery in 2022.
- Fractures of the proximal femur, humerus, and distal radius, along with injuries from accidental falls in the elderly, remained largely unchanged throughout the periods.
Conclusions:
- COVID-19 profoundly altered patterns of orthopaedic trauma, with a notable decline in specific injury types.
- A gradual return to pre-pandemic injury trends is evident as restrictions ease.
- Certain injury patterns, particularly those affecting the elderly, demonstrated resilience to pandemic-related changes.
Abstract:
Background and Objective: On March 2020, our country became a protected area due to the COVID-19 pandemic. The consequences of COVID-19 on trauma surgery were great. We aimed to evaluate the activity of the Trauma Centre of a highly populated suburban area over 30 days starting from the first day of restrictions, to compare it with the same period of 2019 and 2022 and to evaluate whether a progressive return to normality has taken place. Materials and Methods: All patients older than 18 years managed in our Trauma Unit between 8 March 2020 and 8 April 2020 (the first COVID-19 period) were compared to the same period of 2019 (a COVID-19 free period) and 2022 (the second COVID-19 period). Clinical records were examined. Five categories of diagnoses and six mechanisms of injury were distinguished. Results: There were 1351 patients [M:719-F:632; mean age (SD):49.9 (18.7)], 451 [M:228-F:223; mean age (SD):55.9 (18.4)] and 894 [M:423-F:471;mean age (SD):54.1 (16.7)] in the COVID-19 free and in the first and second COVID-19 periods, respectively (p < 0.05). In 2020, the most significant decrease was registered for sprains/subluxations (80%); contusions decrease by 77% while fractures decrease only by 37%. The lowest reduction was found for dislocations (26%). In 2022, dislocations decreased by only 16% and both fractures and sprains decreased by about 30% with respect to the pre-pandemic period. Patients with minor trauma (contusions) were half compared to 2019. Accidental falls remain the most frequent mechanism of injury. The incidence of proximal femur, proximal humerus and distal radius fractures remained almost unchanged during both pre-pandemic and pandemic periods. Conclusions: COVID-19 has markedly altered orthopaedic trauma. Injuries related to sports and high energy trauma/traffic accidents drastically reduced in 2020; however, we are slowly going back to normality: the same injuries increased in 2022 due to the progressive easing of restrictions. Elderly fractures related to accidental falls remained unchanged.
