COVID-19 Crisis Effect: Experience at Two Orthopedic Trauma Units.

BACKGROUND: The coronavirus disease-2019 (COVID-19) crisis has affected how hospitals work and has had an effect on orthopedic surgery. OBJECTIVES: To compare patient management and low-energy and high-energy trauma treatment at two orthopedic trauma units during the COVID-19 crisis and to clarify resource demands and preparedness in orthopedic clinics during the state of emergency caused by the COVID-19 pandemic. METHODS: This retrospective study was conducted at two orthopedic trauma units from 14 March 2019 to 14 April 2019 and from 14 March 2020 to 14 April 2020. RESULTS: The proportion of patients admitted in the multi-trauma orthopedic unit decreased by one-third, the mean time interval from admission to surgery significantly decreased, and the number of surgeries and mean length of stay in hospital decreased in 2020 compared to the same test period in 2019. In the orthopedic trauma unit, the number of patients and surgeries also decreased. CONCLUSIONS: Our study highlights changes in orthopedic injury characteristics in two orthopedic units during the COVID-19 crisis in Latvia and compares these changes to data from the same time period one year earlier.

Impact of the COVID-19 lockdown period on adult musculoskeletal injuries and surgical management: a retrospective monocentric study.

The coronavirus disease 2019 (COVID-19) pandemic has led to the worldwide implementation of unprecedented public protection measures. On the 17th of March, the French government announced a lockdown of the population for 8 weeks. This monocentric study assessed the impact of this lockdown on the musculoskeletal injuries treated at the emergency department as well as the surgical indications. We carried out a retrospective study in the Emergency Department and the Surgery Department of Nantes University Hospital from 18 February to 11 May 2020. We collected data pertaining to the demographics, the mechanism, the type, the severity, and inter-hospital transfer for musculoskeletal injuries from our institution. We compared the 4-week pre-lockdown period and the 8-week lockdown period divided into two 4-week periods: early lockdown and late lockdown. There was a 52.1% decrease in musculoskeletal injuries among patients presenting to the Emergency Department between the pre-lockdown and the lockdown period (weekly incidence: 415.3 ± 44.2 vs. 198.5 ± 46.0, respectively, p < .001). The number of patients with surgical indications decreased by 33.4% (weekly incidence: 44.3 ± 3.8 vs. 28.5 ± 10.2, p = .048). The policy for inter-hospital transfers to private entities resulted in 64 transfers (29.4%) during the lockdown period. There was an increase in the incidence of surgical high severity trauma (Injury Severity Score > 16) between the pre-lockdown and the early lockdown period (2 (1.1%) vs. 7 (7.2%), respectively, p = .010) as well as between the pre-lockdown and the late lockdown period (2 (1.1%) vs. 10 (8.3%), respectively, p = .004). We observed a significant increase in the weekly emergency department patient admissions between the early and the late lockdown period (161.5 ± 22.9, 235.5 ± 27.7, respectively, p = .028). A pronounced decrease in the incidence of musculoskeletal injuries was observed secondary to the lockdown measures, with emergency department patient admissions being halved and surgical indications being reduced by a third. The increase in musculoskeletal injuries during the late confinement period and the higher incidence of severe trauma highlights the importance of maintaining a functional trauma center organization with an inter-hospital transfer policy in case of a COVID-19s wave lockdown.