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

Abstract

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.

Musculoskeletal Attendances to a Minor Injury Department During a Pandemic

“…Reported data seen in this audit demonstrated similarities to the reduction in RTC-related injuries declining by 88.6% however injuries related to sports such as football only reduced by 58.7%. A 52.1% decline in weekly trauma attendances were also reported in France during the period of lockdown [23]. This is consistent with the data seen in this audit with "Limb Problems" which declined by 59.74% during the period of lockdown.…”

“…There have been numerous articles analysing trauma patterns during the COVID-19 outbreak with the pattern of injury changing depending on the country, region and age of the patients [14][15]. During the COVID-19 pandemic emergency departments internationally saw a reported reduction in patients attending during relative periods of lockdown in each country [16][17][18][19][20][21][22][23][24]. Overall attendances to emergency departments were reported to have declined by as much as 68% in Italy [18][19] and 60% in parts of the United States of America [20].…”

Impact of the SARS-CoV-2 pandemic on trauma care: a nationwide observational study

“…Therefore, the 41% and 26% increase frequency of minor (ISS ≤ 15) self-harm-related injuries during the respective first and second waves and the 37% increase in violence-related severe injuries (ISS ≥ 16) during the interbellum are worrisome. Unfortunately, we are not the first to report this, and increased numbers of injuries resulting from self-harm during the periods of lockdown were found in France [ 10 , 11 ], the UK [ 12 , 13 ], Australia [ 14 , 15 ] and the US [ 16 , 17 ]. Preparing for indefinite periods of social restrictions that may lie ahead, policy-makers might want to take precautionary measures to identify and protect those that pose the highest risk of self-harm or domestic abuse and consider additional funding towards mental health services to meet demand.…”

Factors associated with neuromusculoskeletal injury and disability in Navy and Marine Corps personnel

“…A similar phenomenon has been observed in NMSKI-related emergency department visits and surgical procedures in civilian hospitals. 12 The rapid increase in incidence in the latter months of the study epoch corresponds with a period of resumption of regular operations, to include preparation for the fall physical readiness assessment required by the USN and USMC in 2021.…”