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1.
J Pediatr Orthop ; 42(6): 335-340, 2022 Jul 01.
Article in English | MEDLINE | ID: covidwho-1816283

ABSTRACT

BACKGROUND: Hand fractures are among the most common injuries presenting in pediatric emergency departments (EDs) with incidence reported as high as 624 hand fractures per 100,000 person-years. If gone untreated, these injuries can lead to pain, loss of function, and psychological trauma. The purpose of this study was to identify risk factors and characterize pediatric hand fractures over a 5-year period. METHODS: The National Electronic Injury Surveillance System (NEISS) was queried for all hand fractures in patients aged 1 to 19 years presenting to US EDs between 2016 and 2020. Incidence was calculated using US census data. Cases were retrospectively analyzed using age, location of the injury, sex, coronavirus disease-2019 (COVID-19) era, and etiology of injury. Bivariate logistic regression was used where appropriate. RESULTS: A total of 21,031 pediatric hand fractures were identified, representing an estimated 565,833 pediatric hand fractures presenting to EDs between 2016 and 2020. The mean incidence of pediatric hand fractures was 138.3 fractures for 100,000 person-years [95% confidence interval (CI): 136.2-140.4], with a 39.2% decrease in incidence occurring between 2019 and 2020. It was found that 42.2% of the fractures were in patients aged 10 to 14. The incidence of hand fractures for males and females was 97.9 (95% CI: 96.2-99.7) and 40.4 (95% CI: 39.2-41.5), respectively, with the male rate peaking at age 14 and the female rate peaking at age 12. Age, sex, location of the injury, and injury during the COVID-19 pandemic were demonstrated to influence the frequency and etiology of the fracture. CONCLUSION: This study determined the incidence of pediatric hand fractures presenting to EDs across the United States. In addition, it identified risk factors for common hand fracture etiologies (sports-related, falling, crush, punching) and demonstrated the change in rates of different etiologies of pediatric hand fractures that presented to US EDs during the COVID-19 pandemic. LEVEL OF EVIDENCE: Level III-retrospective comparative study.


Subject(s)
COVID-19 , Fractures, Bone , Hand Injuries , Adolescent , COVID-19/epidemiology , Child , Emergency Service, Hospital , Female , Fractures, Bone/epidemiology , Fractures, Bone/etiology , Hand Injuries/epidemiology , Humans , Male , Pandemics , Retrospective Studies , Risk Factors , United States/epidemiology
2.
Sci Rep ; 12(1): 6528, 2022 04 20.
Article in English | MEDLINE | ID: covidwho-1805654

ABSTRACT

This study aimed to investigate the association between COVID-19 and fracture risk and provide a targeted reference for the world through China's experience. A nationally representative sample of COVID-19 prevalence areas selected using stratified random sampling was retrospectively analyzed. Age, sex, fracture site, mechanism of injury, and concurrent fractures of traumatic fracture patients in selected hospitals were collected from 10 January to 10 July 2020. The epidemiologic characteristics of traumatic fractures and the association between COVID-19 and fracture risk were explored using descriptive epidemiological methods and a distributed lag nonlinear model. A total of 67,249 patients (52.3% males, 49.4 ± 19.4 years old) with 68,989 fractures were included. The highest proportion of fractures were in the tibia and fibula (14.9%), followed by the femur (13.6%) and ulna and radius (12.5%). Low-energy fractures accounted for 23.3%. With the increase in newly confirmed COVID-19 cases, fracture risk decreased for children, young and middle-aged adults, elderly men, high-energy fractures, and residents in regions with < 1000 cumulative confirmed COVID-19 cases. Fracture risk decreased sharply in all residents except elderly women, for low-energy fractures, and in regions with > 1000 cumulative confirmed COVID-19 cases when newly confirmed COVID-19 cases increased in China. Primary (home) prevention measures are emphasized to prevent traumatic fractures.


Subject(s)
COVID-19 , Fractures, Bone , Adult , Aged , COVID-19/epidemiology , Child , China/epidemiology , Cities/epidemiology , Female , Fractures, Bone/epidemiology , Fractures, Bone/etiology , Humans , Incidence , Male , Middle Aged , Retrospective Studies
3.
Front Endocrinol (Lausanne) ; 12: 800376, 2021.
Article in English | MEDLINE | ID: covidwho-1662577

ABSTRACT

Background: Although genetic diseases are rare, children with such conditions who get infected with COVID-19 tend to have a severe illness requiring hospitalization. Osteogenesis imperfecta (OI) is a rare genetic disorder of collagen resulting in fractures and skeletal deformities. Kyphoscoliosis, restrictive lung disease, and pneumonia worsen the prognosis of patients with OI. The use of bisphosphonate improves bone mineral density (BMD) and reduces fractures in OI. There is no literature describing the impact of COVID-19 in patients with OI. Methodology: A retrospective multi-center study was performed in three hospitals in Jeddah and Riyadh, Saudi Arabia, from March 1st, 2020, until August 31st, 2021, aiming to evaluate the outcome of COVID-19 in patients with OI. Demographics, vaccination status, underlying kyphoscoliosis, functional status, use of bisphosphonate, BMD, and COVID-19 severity, and course were recorded for all patients. Results: Twelve cases of confirmed COVID-19 were identified among 146 patients with OI. 9 (75%) of patients were less than 18 years, 6 (50%) were male, 5 (41%) had kyphoscoliosis, and 5 (41%) were wheelchair-bound. 6 (50%) received bisphosphonate, and 7(58%) had normal BMD. All patients had mild disease and did not require hospitalization. None of OI the patients with COVID-19 were fully vaccinated before the infection, and some were ineligible for vaccination. Conclusion: Patients with OI and COVID-19 in our study recovered without complications, unlike patients with other genetic diseases. Young age and mild illness contributed to the favorable outcome. Half of the patients received bisphosphonate and had normal BMD.


Subject(s)
COVID-19/complications , Osteogenesis Imperfecta/therapy , SARS-CoV-2/isolation & purification , Adolescent , Adult , Bone Density , COVID-19/transmission , COVID-19/virology , Child , Diphosphonates/therapeutic use , Female , Follow-Up Studies , Fractures, Bone/drug therapy , Fractures, Bone/etiology , Fractures, Bone/pathology , Hospitalization , Humans , Male , Osteogenesis Imperfecta/epidemiology , Osteogenesis Imperfecta/virology , Prognosis , Retrospective Studies , Saudi Arabia/epidemiology , Young Adult
4.
Eur J Pediatr ; 181(4): 1473-1480, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1620262

ABSTRACT

The COVID-19 pandemic led to fundamental changes in daily routines of children. Our aim was to evaluate the incidence and characteristics of fractures among Israeli children during 2020 compared with 2015-2019. Demographic, clinical data, and incidence rates of fractures in individuals aged < 18 years were derived from the electronic database of Meuhedet Health Services, which provides healthcare services to 1.2 million people in Israel. We further subdivided the year to five periods according to government regulations of lockdown and isolation at each period. Fracture sites were determined according to ICD9 definitions. During 2020, 10,701 fractures occurred compared with 12,574 ± 599 fractures per year during 2015-2019 (p-value < 0.001). Fracture rates were lower during all periods in 2020. The largest decline was observed during the first lockdown for both boys (56% decline, 95% confidence interval [CI] 52-60%) and girls (47% decline CI 41-53%). While the fracture rate declined for most age groups, the largest decline was recorded for the age group 11-14 years, with significant reduction rates of 66% (CI 59-71%) for boys and 65% (CI 54-73%) for girls. The most prominent declines were of fractures of the hand bones of both boys and girls (64% and 59%, respectively). Conclusions: Our data showed a significant decrease in fracture rate in 2020 compared to the previous 5 years, as well as differences between periods within that year. What is New: •The COVID-19 pandemic led to fundamental change in daily routines of children with significant decrease in school attendance and sport activities. •Consequent to these public health measures, the incidence rate of pediatric fractures decreased significantly. What is New: •This study demonstrates declines in fracture rates during lockdown periods, with only partial reversing of the trends between the lockdown periods. •The most pronounced decline was observed during the first lockdown period. •The decline was most prominent in children aged 11-14 years; there was no significant change in fracture incidence of children aged <3 years.


Subject(s)
COVID-19 , Fractures, Bone , Adolescent , COVID-19/epidemiology , COVID-19/prevention & control , Child , Child, Preschool , Cohort Studies , Communicable Disease Control , Female , Fractures, Bone/epidemiology , Fractures, Bone/etiology , Humans , Incidence , Male , Pandemics
5.
Acta Orthop Traumatol Turc ; 55(3): 191-195, 2021 May.
Article in English | MEDLINE | ID: covidwho-1261416

ABSTRACT

OBJECTIVE: This study aimed to investigate whether various curfew practices affect trauma prevalence, epidemiological differences among the population admitted to hospital because of trauma, and treatment practices used after trauma. METHODS: Patients who suffered from fractures or soft-tissue trauma between March 21, 2020, and June 1, 2020, (group pandemic) and during the same period in 2019 (control group) were included in our single-center retrospective study. Each group was also divided into 3 subgroups according to the age of patients (≤ 20 years, 21-64 years, and ≥ 65 years). Data including anatomical region subjected to trauma, place of admission, mechanism of trauma, location of trauma, mode of treatment, type of surgery (if performed), duration of hospitalization (if hospitalized), time elapsed until surgery, and duration of postoperative hospitalization were collected and compared between groups. RESULTS: A total of 361 patients were admitted to the hospital with new trauma during the pandemic, and 708 patients had been admitted during the same period in 2019. The number of admissions decreased significantly by 50.9% (P < 0.001). The mechanism of trauma that occurred with low energy was significantly increased in the pandemic group (73.9%) compared with the control group (47.6%) (P < 0.001). Similarly, the distribution of trauma throughout the skeletal system, especially in the upper extremity, was significantly increased in the pandemic group (49.9% vs. 30.5%, P < 0.001). However, there was no significant decrease in individuals aged above 65 years (P = 0.115). Similar to the general outlook, the 3 groups differed in terms of the mechanism of trauma, location of trauma, and distribution of the anatomical region subjected to trauma (P < 0.001). Majority of the patients received inpatient treatment in all 3 groups (P < 0.001). CONCLUSION: The results of this study showed that the pandemic dramatically reduced the number of hospital admissions related to orthopedic trauma. The rate of low energy, upper extremity traumas that occurred indoors increased during the pandemic period compared with that of the previous year. However, the rate of hospital admissions did not differ in the ≥65-year-old subgroup during the pandemic period compared with that of the previous year.


Subject(s)
COVID-19 , Communicable Disease Control/methods , Fractures, Bone , Hospitalization/statistics & numerical data , Adult , Age Factors , Aged , COVID-19/epidemiology , COVID-19/prevention & control , Child , Female , Fractures, Bone/epidemiology , Fractures, Bone/etiology , Fractures, Bone/therapy , Humans , Male , Prevalence , Retrospective Studies , SARS-CoV-2 , Tertiary Care Centers/statistics & numerical data , Turkey/epidemiology
6.
BMJ Case Rep ; 14(5)2021 May 07.
Article in English | MEDLINE | ID: covidwho-1223561

ABSTRACT

We present an unusual case of phalangeal fracture resulting from direct penetration by the barb of a conducted electrical weapon (Taser). When a Taser is triggered, compressed gas propels two barbs with trailing insulated wires which deliver a pulsed electrical discharge on contact. A 51-year-old man presented with a single barb of the Taser embedded in the diaphysis of the proximal phalanx and an associated open fracture. The barb was removed under local anaesthesia. The fracture was stable and was mobilised in a flexible splint. Oral antibiotics were commenced in recognition of the risk of flexor sheath and bone inoculation. While the most severe complications associated with Taser are related to the electrical component, the most common injuries are associated with falls and barb penetrations. Clinicians must be mindful of the risk of fracture, infection and soft tissue injury when such a foreign body penetrates a phalanx.


Subject(s)
Finger Phalanges , Fractures, Bone , Accidental Falls , Bone Wires , Fractures, Bone/diagnostic imaging , Fractures, Bone/etiology , Fractures, Bone/surgery , Humans , Male , Middle Aged
7.
Ann R Coll Surg Engl ; 103(3): 160-166, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-1110065

ABSTRACT

INTRODUCTION: The COVID-19 pandemic resulted in reconfiguration of the NHS. Elective services were stopped and trauma services focused on decreasing patient-clinician interactions and managing injuries nonoperatively wherever possible. The everyday life of the general public changed dramatically with the introduction of a national lockdown to prevent the spread of COVID-19. This paper looks at the experience of a South West London trauma unit. MATERIALS AND METHODS: All patients reviewed in fracture clinic and by the orthopaedic on-call team between 23 March to 23 April 2020 were included. Data on the mechanism of injury and whether this was a usual activity, the injury sustained and its management were collected. RESULTS: A total of 167 trauma injuries were seen, compared with 735 new patients with injuries in the previous month. The number of trauma operations completed decreased by 38%; 55% of injuries occurred inside the home and 44% outside the home during daily exercise. Some 31% of injuries were secondary to a new activity taken up during lockdown. Three open fractures and two polytrauma cases were seen that would have normally been managed at the local major trauma centre. CONCLUSION: Overall, both the number of injuries seen and trauma operations completed during the enforced lockdown decreased. This is probably due to a change in the way the general public are living their lives, and the reconfigurations within the NHS in response to the COVID-19 pandemic. This is an interesting time within trauma and orthopaedic departments, as they continue to adapt to the changing injuries and working environment.


Subject(s)
Accidents, Home/statistics & numerical data , Exercise , Fractures, Bone/epidemiology , Trauma Centers , Accidental Falls/statistics & numerical data , Adolescent , Adult , Aged , Aged, 80 and over , Bicycling/injuries , COVID-19/prevention & control , Child , Child, Preschool , Communicable Disease Control , Female , Femoral Neck Fractures/epidemiology , Femoral Neck Fractures/etiology , Femoral Neck Fractures/surgery , Fracture Fixation, Internal , Fractures, Bone/etiology , Fractures, Bone/surgery , Gardening , Humans , Infant , London/epidemiology , Male , Middle Aged , Radius Fractures/epidemiology , Radius Fractures/etiology , Radius Fractures/surgery , SARS-CoV-2 , Young Adult
8.
Injury ; 52(3): 395-401, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-1087000

ABSTRACT

PURPOSE: The aim of this study was to evaluate changes in both mechanism and diagnoses of injuries presenting to the orthopaedic department during this lockdown period, as well as to observe any changes in operative case-mix during this time. METHODS: A study period of twelve weeks following the introduction of the nationwide "lockdown period", March 23rd - June 14th, 2020 was identified and compared to the same time period in 2019 as a "baseline period". A retrospective analysis of all emergency orthopaedic referrals and surgical procedures performed during these time frames was undertaken. All data was collected and screened using the 'eTrauma' management platform (Open Medical, UK). The study included data from a five NHS Foundation Trusts within North West London. A total of 6695 referrals were included for analysis. RESULTS: The total number of referrals received during the lockdown period fell by 35.3% (n=2631) compared to the same period in 2019 (n=4064). Falls remained proportionally the most common mechanism of injury across all age groups in both time periods. The proportion sports related injuries compared to the overall number of injuries fell significantly during the lockdown period (p<0.001), however, the proportion of pushbike related accidents increased significantly (p<0.001). The total number of operations performed during the lockdown period fell by 38.8% (n=1046) during lockdown (n=1732). The proportion of patients undergoing operative intervention for Neck of Femur (NOF) and ankle fractures remained similar during both study periods. A more non-operative approach was seen in the management of wrist fractures, with 41.4% of injuries undergoing an operation during the lockdown period compared to 58.6% at baseline (p<0.001). CONCLUSION: In conclusion, the nationwide lockdown has led to a decrease in emergency orthopaedic referrals and procedure numbers. There has been a change in mechanism of injuries, with fewer sporting injuries, conversely, there has been an increase in the number of pushbike or scooter related injuries during the lockdown period. NOF fractures remained at similar levels to the previous year. There was a change in strategy for managing distal radius fractures with more fractures being treated non-operatively.


Subject(s)
Accidental Falls/statistics & numerical data , Accidents, Traffic/trends , Bicycling/injuries , COVID-19 , Orthopedic Procedures/trends , Referral and Consultation/trends , Wounds and Injuries/epidemiology , Adolescent , Adult , Aged , Arm Injuries/epidemiology , Arm Injuries/etiology , Arm Injuries/therapy , Athletic Injuries/epidemiology , Athletic Injuries/therapy , Child , Child, Preschool , Diagnosis-Related Groups , Female , Femoral Neck Fractures/epidemiology , Femoral Neck Fractures/surgery , Fractures, Bone/epidemiology , Fractures, Bone/etiology , Fractures, Bone/therapy , Fractures, Open/epidemiology , Fractures, Open/etiology , Fractures, Open/therapy , Humans , Infant , Infant, Newborn , Leg Injuries/epidemiology , Leg Injuries/etiology , Leg Injuries/therapy , London/epidemiology , Male , Middle Aged , SARS-CoV-2 , Trauma Centers , Wounds and Injuries/etiology , Wounds and Injuries/therapy , Wrist Injuries/epidemiology , Wrist Injuries/etiology , Wrist Injuries/therapy , Young Adult
9.
PLoS One ; 16(2): e0246956, 2021.
Article in English | MEDLINE | ID: covidwho-1085151

ABSTRACT

BACKGROUND: The COVID-19 pandemic led to the implementation of drastic shutdown measures worldwide. While quarantine, self-isolation and shutdown laws helped to effectively contain and control the spread of SARS-CoV-2, the impact of COVID-19 shutdowns on trauma care in emergency departments (EDs) remains elusive. METHODS: All ED patient records from the 35-day COVID-19 shutdown (SHUTDOWN) period were retrospectively compared to a calendar-matched control period in 2019 (CTRL) as well as to a pre (PRE)- and post (POST)-shutdown period in an academic Level I Trauma Center in Berlin, Germany. Total patient and orthopedic trauma cases and contacts as well as trauma causes and injury patterns were evaluated during respective periods regarding absolute numbers, incidence rate ratios (IRRs) and risk ratios (RRs). FINDINGS: Daily total patient cases (SHUTDOWN vs. CTRL, 106.94 vs. 167.54) and orthopedic trauma cases (SHUTDOWN vs. CTRL, 30.91 vs. 52.06) decreased during the SHUTDOWN compared to the CTRL period with IRRs of 0.64 and 0.59. While absolute numbers decreased for most trauma causes during the SHUTDOWN period, we observed increased incidence proportions of household injuries and bicycle accidents with RRs of 1.31 and 1.68 respectively. An RR of 2.41 was observed for injuries due to domestic violence. We further recorded increased incidence proportions of acute and regular substance abuse during the SHUTDOWN period with RRs of 1.63 and 3.22, respectively. CONCLUSIONS: While we observed a relevant decrease in total patient cases, relative proportions of specific trauma causes and injury patterns increased during the COVID-19 shutdown in Berlin, Germany. As government programs offered prompt financial aid during the pandemic to individuals and businesses, additional social support may be considered for vulnerable domestic environments.


Subject(s)
COVID-19/epidemiology , Fractures, Bone/epidemiology , Quarantine/statistics & numerical data , Trauma Centers/statistics & numerical data , COVID-19/prevention & control , Fractures, Bone/classification , Fractures, Bone/etiology , Germany , Hospitals, University/statistics & numerical data , Humans
10.
ANZ J Surg ; 90(11): 2237-2241, 2020 11.
Article in English | MEDLINE | ID: covidwho-772474

ABSTRACT

BACKGROUND: The coronavirus disease outbreak in December 2019 rapidly spread around the world with profound effects on healthcare systems. In March 2020, all elective surgery and elective outpatient clinics were cancelled in our institution, a regional hospital in Northern New South Wales, Australia. With regard to orthopaedic fracture clinics, a telehealth system was implemented on an emergency basis for patient and staff safety to prevent disease transmission. The aim of our study was to investigate whether rapid implementation of telehealth for orthopaedic fracture clinics resulted in an increase in complications. METHODS: A retrospective cohort study of all patients with orthopaedic fracture clinic appointments at a regional New South Wales hospital between 17 March and 8 May 2020 was undertaken. There were 191 patients, including 390 appointments of which 23.1% were conducted via telehealth, namely by phone call. Complications requiring phone calls to the orthopaedic team, presentations to the emergency department, admission to hospital or return to theatre, were recorded. RESULTS: There was no increase in complications following emergent implementation of telehealth for orthopaedic fracture clinic follow-up in our institution. Patients in the telehealth group were significantly older than those in the clinic group. CONCLUSION: The study demonstrates that application of telehealth fracture clinics in a regional Australian setting can be achieved without increasing complication rates and can be used to formulate a rapid telehealth implementation plan if a similar scenario occurs in the future.


Subject(s)
Ambulatory Care/organization & administration , Betacoronavirus , Coronavirus Infections/epidemiology , Fractures, Bone/therapy , Pneumonia, Viral/epidemiology , Telemedicine/organization & administration , Adolescent , Adult , Aged , Aged, 80 and over , Ambulatory Care Facilities , COVID-19 , Child , Child, Preschool , Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , Female , Fractures, Bone/diagnosis , Fractures, Bone/etiology , Humans , Infant , Male , Middle Aged , New South Wales , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission , Retrospective Studies , SARS-CoV-2 , Young Adult
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