Consequences of the COVID-19 pandemic on fracture distribution: Epidemiological data from a tertiary trauma center in Turkey

Abstract

Redefinition of our social life for COVID-19, with social distance, prohibition of entering and exiting cities, closure of social areas and curfews effects every aspect of our lives, from psychological to physical. The aim of this study was to evaluate the injury mechanisms, fracture frequencies and priority treatment preferences in a tertiary trauma center from Turkey during the COVID-19 pandemic, both in adult and pediatric populations, and to compare them with pre-COVID-19 period. In this single-centered study, 960 patients (with 1039 fractures) who were admitted to a tertiary trauma center in Turkey, between April 2020 and December 2020 were examined. A control group of 964 patients (with 1070 fractures) who were admitted in the same date range of 2019 was formed. Patient demographics, injury mechanisms, fracture type and preferred treatment methods were recorded. There was a significant difference regarding injury mechanism between groups in both adult and pediatric populations (p=0.002 and p<0.001, respectively). In adults, according to the residual values, there was significant difference between groups in terms of proximal humerus, elbow, forearm, hand, femoral shaft and knee fractures (p<0.001). Among pediatric patients, a significant difference was found between groups in terms of proximal humerus, hand and knee fractures (p<0.001). In the pediatric population, there has been a significant increase in the preference of conservative treatment in the pandemic group (p=0.002). With increased indoors time, restriction of outdoors physical activities and lesser time in traffic, fracture distribution and priority treatment preferences have inevitably changed. In Turkey, the frequency of almost all upper extremity fractures except proximal humerus and humerus shaft fractures have increased significantly in the adult population, while the frequency of lower extremity fractures associated with high-energy injuries have decreased. In the pediatric population, treatment preferences are shifting towards conservative methods rather than surgery during the COVID-19 pandemic.

The impact of curfews on emergency departments and orthopedic traumas

“…It is a logical assumption that, with increased indoor time, common reasons for fractures such as traffic accidents will decline whereas minor fractures due to domestic accidents will increase. [ 23 ] These results can be explained by the changes in people’s daily habits, social activities, and working patterns due to the curfews.…”

Internet and social media preferences of orthopaedic patients vary according to factors such as age and education levels

“…In 2014, Curry et al (2014) reported that 50% of orthopaedic patients used the internet for health problems, and 26% did preliminary research before visiting a doctor. Moreover, during the pandemic, extraordinary measures have been taken all over the world, and citizens have had to spend a long time in their homes (Gencer & Doğan, 2022; Yavuz et al, 2021). This situation has changed habits and promoted the use of the internet and social media.…”

“…Moreover, the easier access to information triggers patients' tendency to self‐medicate or to research their diseases before seeing a physician. Especially since March 2020, after the outbreak of the COVID‐19 pandemic, the rate of patients doing preliminary research and self‐medicating by resorting to the internet have increased significantly, considering that people got used to living for a long time due to the circumstances of restrictions such as the curfews (Gencer & Doğan, 2022; Gencer, Çulcu, & Doğan, 2022).…”

Çekilmiş Dirsek Sendromunda Radyolojik Analizin Gerekliliğinin İncelenmesi

“…Approximately one-fourth of childhood injuries involve the elbow area. 16 Although most of them are supracondylar fractures, the pulled elbow should be kept in mind, especially in children under six years of age with a history of sudden traction. 1,2,5,6 As mentioned before, the prevailing view in the literature is that the diagnosis of the pulled elbow should be made clinically, and unnecessary radiation should be avoided.…”