Effect of Covid-19 on Fragility Fracture Admission in a Tertiary Teaching Hospital in Malaysia

ABSTRACT

Introduction: COVID-19 has led to a change in the health-seeking behaviour and the delivery of healthcare. Globally, fragility fracture admissions have reduced by 0-54% depending on location. When Malaysia implemented the third movement control order on 3 May 2021 in response to increasing COVID-19 cases, the number of orthopaedic beds in the University Malaya Medical Centre was reduced from over a hundred to twenty-eight. To date, the impact of COVID-19 on fragility fracture admission in Malaysia is unknown. This study aims to investigate the relationship between COVID-19 cases and fragility fracture admissions to a tertiary hospital in Malaysia. Methods: This retrospective study was conducted from April to June 2021 in the University Malaya Medical Centre. The patients admitted to the University Malaya Medical Centre with fragility fractures between April and June 2021 were identified and compared to the corresponding periods in 2018. Patients <50 years old and those who had fractures due to cancer were excluded. The relationship between the total number of COVID-19 cases per week and weekly fragility fractures admissions were determined. Results: A total of 406,479 COVID-19 cases were reported over 3 months (April, n = 63,213;May, n = 163,644;June, n = 179,622). Fifty-five patients [mean age (78.9±8.6), female (44/55,80%), hip fractures (36/55,65.5%)] were admitted in April-June 2021, which was a 35.3% reduction when compared to the same period in 2018 [n = 85, mean age (75.1±9.9), female (62/85,72.9%), hip fractures (53/85,62.4%)], although no significant difference was found between the baseline characteristics. However, both fragility fracture and hip fracture admissions were found to be negatively correlated (r =-0.76 and r =-0.75) with the COVID-19 cases (P < 0.01). Twelve (12/51,23.5%) patients admitted in 2021 due to post-fall fragility fractures presented to the hospital more than a day after their injury. The proportion of patients with delayed presentation (>1 day post-fall) increased over the study period (April = 5/26, 19.2%;May = 3/13, 23.1%;June = 4/12, 33.3%). Conclusion: There was a reduction in fragility fracture admissions during the COVID outbreak in Malaysia. There might be a rebound in cases after the COVID crisis is over, reorganising medical services may be warranted to ensure effective fracture care delivery.