From Lockdown to Knockdown: The Return of Violence and Sport in Post-COVID Nasal Fractures

The coronavirus disease 2019 (COVID-19) pandemic altered nasal fracture epidemiology, with fewer outdoor injuries and more domestic accidents. This study compared intra-pandemic and post-pandemic nasal fracture patterns and their prevention implications.

This retrospective study included patients treated for nasal fractures during February 2020-January 2021 (intra-pandemic) and February 2023-January 2024 (post-pandemic). The post-pandemic cohort was identified using the same eligibility criteria, variable definitions, coding framework, and electronic-record retrieval procedure as the previously published intra-pandemic cohort. The predefined objective was a direct comparison of these two matched periods; no pre-pandemic control group was included.

A total of 290 patients were analyzed (184 post-pandemic and 106 intra-pandemic). In exploratory unadjusted comparisons, sports accidents occurred in 29/184 (15.8%) post-pandemic versus 7/106 (6.6%) intra-pandemic cases (p = 0.023), road traffic incidents in 31/184 (16.8%) versus 7/106 (6.6%) (p = 0.041), interpersonal violence in 60/184 (32.6%) versus 20/106 (18.9%) (p = 0.009), and alcohol-related events in 37/184 (20.1%) versus 7/106 (6.6%) (p = 0.009). Falls, virus- or flu-associated syncope, and accidents at home were more frequent intra-pandemic. Because multiple comparisons were performed, findings with p-values near 0.05 should be regarded as nominal and hypothesis-generating. The unadjusted mean hospital stay was shorter post-pandemic; however, the study period was not independently associated with length of stay after adjustment. The post-pandemic period showed a borderline, non-significant association with violence-related fractures (odds ratio 1.76, 95% confidence interval 0.99-3.12; p = 0.051).

The observed changes are compatible with a return of social, recreational, and traffic-related trauma patterns, although the absence of a pre-pandemic control group and the exploratory nature of subgroup analyses limit causal interpretation. Differences in hospital stay appear to be more closely related to patient-level characteristics than to the study period itself.