key: cord-0730829-z0pefmwc
authors: Gumina, S.; Proietti, R.; Villani, C.; Carbone, S.; Candela, V.
title: The impact of COVID-19 on shoulder and elbow trauma in skeletally immature population. An Italian survey
date: 2020-09-21
journal: JSES Int
DOI: 10.1016/j.jseint.2020.08.003
sha: bc72cf01baa612002ac92d1f143c1d3174a4f22a
doc_id: 730829
cord_uid: z0pefmwc

BACKGROUND: Aim of this study was to evaluate the impact of COVID-19 on the shoulder and elbow trauma in a skeletally immature population in 30 days starting from the March 8 2020, the first day of restrictions in Italy, and to compare it with the same days of 2019. MATERIALS AND METHODS: All the skeletally immature (younger than 18 ys) patients managed in the Emergency Unit of our Hospital between March 8 2020 and 8(th)April 2020 (COVID-19 period, C19) for a shoulder and elbow trauma were retrospectively included and compared to patients with similar ages admitted in the same period of 2019 (no COVID-19 period, NC19). Six categories of diagnosis were distinguished: 1) contusions, 2) no physeal fractures, 3) physeal fractures (Salter-Harris), 4) sprains/subluxations,5) dislocations, 6) others (tendinitis, wounds, low back pain, joint inflammation). According to the mechanism of injury we arbitrarily distinguished 6 subgroups: a) Accidental fall;b) Sport trauma; c) Accident at school; d) High energy trauma occurred by car, public transport, pedestrian investment; e) Fall from high. RESULTS: During the C19 period, the number of total accesses in our Trauma Center steeply decreased: two thirds less. Regardless of the patient age, we performed 65% less first aid shoulder/elbow services. Skeletally immature patients treated at our Trauma Center for all types of injury during the NC19 period were 350 and 54 during the C19 period; therefore, the influx of pediatric patients during the C19 period decreased by 84.6%. Furthermore: a) in the C19 period there were no cases of fractures, physeal fractures and dislocations of the shoulder; b) in the C19 period we had no cases of contusion, physeal fractures, and dislocations of the elbow; c) during the C19 period we observed the absence of high-energy, sports and school injuries; d) during the pandemic, shoulder and elbow injuries mainly occurred as a result of accidental fall at home. CONCLUSIONS: The pandemic forced us to become aware of the ways and places where skeletally immature subjects report shoulder and elbow traumas; therefore, it would be desirable that more considerable attention be directed towards the prevention of injury in areas at risk.

On January 29, 2020, the Italian Authorities declared the first cases of Coronavirus in Italy: two 32

Chinese tourists received hospitalization at the reference center for infectious diseases in Rome. 33

Further, an Italian researcher from China with Covid-19 and a seventeen-year-old with flu-like 34 symptoms but harmful for Covid-19, who stayed in Wuhan for a long time, were hospitalized at the 35 same hospital in the same days. 36

On January 30, the World Health Organization (WHO) announced the global state of emergency 37 and on February 11 the name Covid-19 was given to the disease gave a name to the new disease, 38

and Sars-CoV-2 to the virus 16 . 39

On February 21, in Italy, several non-imported cases of Covid-19 emerged in Lombardy (the most 40 populated region of Italy). The affected cities were closed so that nobody could leave or enter. 41

Suddenly, the Covid-19 infections continued to rise, and on March 4, the Italian Government 42 closed schools, sports clubs, public parks. All forms of social aggregation were forbidden. At that 43 time, the positive cases of Covid-19 were about three thousand. 44

On March 8, Lombardy, the most affected region, and 14 other provinces were isolated. The 45 affected areas became "red zones." On the same day, the Italian prime minister announced that the 46 restrictions imposed on Lombardy and the other 14 provinces were extended to the whole Country. 47

Hence, Italy became a "protected area." Everybody was told not to leave their homes unless for an 48 essential and documented reason. Smart working was imposed; movement was strictly limited, and 49 on March 22 the Government forbade unnecessary travel between towns. Travel was only allowed 50 for "urgent, verifiable work situations and emergencies or health reasons." People who tested 51 positive for COVID-19 must not leave their homes for any reason. At the same time, anyone with 52 fever or respiratory symptoms are strongly encouraged to stay at home and limit social contact, 53 including with their family doctor. 54 J o u r n a l P r e -p r o o f COVID-19 and shoulder/elbow pediatric trauma The latest step in Italian Coronavirus lockdown was to close down all productive activities 55 throughout the territory that is not considered strictly necessary, crucial, indispensable, to guarantee 56 essential goods and services, starting from March 28. All this information can be extracted from the 57 Italian Civil Protection website 15 . 58

The restrictions mentioned above inevitably affected the Orthopaedic practices, in particular 59 Trauma Centres. While the impact of COVID-19 on adult trauma surgery has been partially 60 elucidated, little is known regarding the pediatric population; therefore, we aimed to evaluate the In the NC19 period, in our Trauma Center, there were 1699 cases; in the same month of the 86 following year (C19 period), the accesses were 528: two thirds less. In Europe, our Country was the first to adopt restrictive measures that prevented citizens from 102 leaving home, except for proven health or working needs. 103

Our Trauma Centre is a certified COVID-19 free unit of a highly-populated area, thus attracting 104 all traumatized patients; this aspect makes our study methodologically valid for evaluating the 105 COVID-19 impact. In our Trauma Center, during the C19 period, we performed 69% fewer services 106 than the same period of the previous year. The reduction also affected the performance aimed at the 107 treatment of shoulder and elbow injuries (-65%). Data relating to the decrease in total treatments in 108 the pediatric population is even more striking: -84.6%; instead, the reduction for shoulder and 109 elbow care was in line with that recorded in the adult population: -66%. 110

The fear of a possible contagion played an important role. Pediatric patient parents, whose 111 children suffering minor trauma or low-intensity pain, were probably discouraged from bringing 112 their sons/daughters to trauma Centres. On the contrary, they would not hesitate to bring their 

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No COVID-19 period 6 3 3 10,3 (4,1) 3