Orthopedic and trauma care during COVID-19 lockdown in Apulia: what the pandemic could not change

BACKGROUND: This study aimed to evaluate the impact of COVID-19 lockdown on Orthopedic and Trauma Care in Apulia, using as a reference point the orthopedic activity performed in the previous three years in the same bimester, and to assess any relationship between the COVID-19 spreading in Apulia and changes in orthopedic and trauma working activity. METHODS: Eight Apulian level 1 or level 2 orthopedic and trauma centers took part in the present study. In each trauma center, between March 9 and May 3 (eight weeks), the following data were prospectively recorded: the number of patients referring to Orthopedic and Trauma Emergency Room (ER) and their cause of injury (i.e. motor vehicle accident, domestic injury, working injury or sports injury); the number of patients referring to outpatient department and the number and type of surgical interventions performed. All trauma centers were also asked to gather the data summarizing surgical, outpatient and ER activities during the same period in the previous three years (2017-2019). Furthermore, data about COVID-19 total confirmed cases and total deaths in Apulia were daily recorded. RESULTS: During COVID-19 lockdown, the mean number of trauma surgeries performed for non-femur fractures, and the mean number of Orthopedic ER referrals for motor vehicle accidents, work injuries and sports injuries were significantly reduced, compared with the same period in the previous three years. Nonetheless, no significant differences were observed in domestic injuries (P=0.1417) and PFFs (P=0.5462). The mortality rate at discharge in patients with PFFs during COVID-19 lockdown, compared with the same period in the previous three years, was not statistically different (P=0.162). A significantly positive correlation was observed between the COVID-19 total cases number and PFFs patients' discharge to home (P=0.003), whereas a significant negative correlation was recorded with PFFs patients' discharge to rehabilitation centers (P=0.001). CONCLUSIONS: Although orthopedic and trauma care significantly changed in Apulia during COVID-19 lockdown. the mean number of patients referring to Orthopedic and Trauma ER for home injuries and PFFs showed no significant differences, compared to the same bimester in the previous three years.