key: cord-0977985-27n1ajbc authors: Vatsya, Pulak; Garika, Siva Srivastava; Mittal, Samarth; Trikha, Vivek; Sharma, Vijay; Malhotra, Rajesh title: Lockdown imposition due to COVID-19 and its effect on orthopedic emergency department in level 1 trauma center in South Asia date: 2022-03-24 journal: J Clin Orthop Trauma DOI: 10.1016/j.jcot.2022.101826 sha: b705be6de0867d91400d07fc81a7c4e12ad651e1 doc_id: 977985 cord_uid: 27n1ajbc BACKGROUND: The coronavirus pandemic brought the entire world to a standstill. One of the most stringent lockdowns in the world was implemented in India. With the entire healthcare system being stretched, emergency orthopaedic services also take a hit. We studied the trends in patient presentation, testing, management, and restructuring of doctors at a tertiary care orthopaedic centre and compared them with the data from the same time period the previous year (2019). METHOD: Data was collected separately for all the 5 different phases of lockdown and unlock, as well as for the same duration of months in 2019, and was analysed for epidemiological trends. RESULTS: A rapid fall in the total number of cases was seen during the lockdown, followed by a skewed rise during the unlock. Forearm, wrist, and hip fractures were the most common fractures. Once nucleic acid testing of all patients intended to be admitted was started, a steep rise in coronavirus positivity was seen. There was a reduction in the total number of cases compared to 2019, but it was not as significant as would have been expected due to the complete standstill of activity during the lockdown. CONCLUSION: During a pandemic, with the healthcare system under a crisis of workforce and infrastructure, there needs to be a separate task force for catering to orthopaedic emergencies since all fractures cannot be managed conservatively and the numbers of trauma-related patients did not show a stark fall as compared to normal months of last year. LEVEL OF EVIDENCE: Level 3 Retrospective Case Series The first case of COVID-19 was reported in India on January 30, 2020, long before it was 34 declared as a pandemic by the WHO on March 11, 2020. [1][2] Taking cognizance of the 35 seriousness, the Indian government evoked the 123-year-old Epidemic Disease Act, 1987, to 36 enhance preparedness and containment of the viral disease. The first 100 cases were 37 confirmed on March 15th, 2020. Accordingly, on March 22 nd , a one-day Janta curfew (public 38 curfew) was observed and air travel was banned as a measure to contain the spread. 39 Meanwhile, following the lead of other countries, a nationwide lockdown was imposed 40 beginning March 25th and lasting 21 days until April 14th.aking leads from other countries, a 41 nationwide lockdown was implemented from 25th March onwards for 21 days till 14th 42 April. Due to the continuing spread and multiple super-spreader incidents, the lockdown was 43 further extended till May 30th, in 4 staged phases. On May 30, 2020, the government of India 44 announced the return of services in a phased manner, except in containment zones. This was 45 termed "Unlock 1.0." [3] 46 As of July 2021, India had more than 3.13 crore cases (active and cured) of COVID-19 and 4. 19 47 This phase saw the opening of all major businesses, including shopping complexes, malls, 108 restaurants, dine-in, domestic travel by road, rail, and air, as well as restricted religious and 109 social gatherings in a phased manner. Masks and social distancing were made compulsory, 110 like all the previous phases. 111 The appropriate ethical clearance was obtained from the Institute Ethics Committee via 112 reference number IEC-1227/2020. The inclusion criterion for our study included patients of 113 any age presenting to the Accident and Trauma Emergency Department of our Tertiary 114 Trauma Centre in New Delhi, India and needing any orthopaedic consult. If the same patient 115 visited the emergency room more than once for follow-up of the same condition, the 116 subsequent visits were not included. 117 The variables collected were: age, gender, diagnosis, COVID RT-PCR status, admitted for 118 surgery, discharged. 119 Screening was done for COVID-19 on the basis of a questionnaire which stratified the patients 120 into high or low risk on the basis of recent history of cold, cough/fever, contact with a positive 121 patient, recent history of travel, or residing in a hotspot area. Ma common modes of injury were road traffic accidents, followed by assaults, domestic violence, 150 and falls at home, in that order. None of these showed a significant difference. (p>0.05) 151 Forearm/ wrist and hip fractures were the commonest fractures without any significant 152 differences amongst the five phases (p >0.05). (Figure 1 ) The number of admissions also 153 increased with the advancing phases but showed no significant difference (p >0.05). A stark 154 rise in COVID+ cases was detected during the unlock 1.0, which was statistically significant 155 compared to the previous phases. (p<0.05) 156 A total of 6241 patients were presented during the same time period in the previous year. 160 (Table 2 ) This number did not show a statistical fall during the pandemic. (p>0.05) Of these, 161 584 patients were admitted for surgical intervention, which was significantly higher than the 162 admission advised during the pandemic (p<0.05). The majority of the patients belonged to 163 the 16-49 year age group, the same as the pandemic population. Octogenarians constituted 164 1% of the entire patient group. The mean age was 44 years. The sex ratio was 60:40, male to 165 female. There were 466 (7.4%) compound cases. The most common mode of injury was a 166 road traffic accident, followed by a fall from a height. Road traffic accidents were significantly 167 more frequent than all other modes of injury (p<0.05). The most common fractures were 168 shaft of femur and wrist fractures, closely followed by hip fractures, although the mean age 169 of the hip fracture group was less than the mean age of the hip fracture group which 170 presented during COVID times. showed that there was no reduction in hip fracture related referrals even during peak 195 pandemic months. [10] They also mentioned that the number of road traffic accident-related 196 injuries did not reduce significantly, since the roads were emptier and, thus, there were more 197 episodes of high-speed and rash driving. We also saw a rise in geriatric trauma, which was 198 equivalent to the numbers from the previous year, but a significant fall in road accidents in 199 our population, similar to other developing countries. Also, a rise in domestic violence and 200 assault cases was noticed. J o u r n a l P r e -p r o o f WHO declares COVID-19 a pandemic A Novel Coronavirus from 353 Patients with Pneumonia in China Implementing the Epidemic Diseases Act to combat Covid-19 in India: An 355 ethical analysis Situation of india in the COVID-19 pandemic: India's initial pandemic experience COVID-19 on orthopedic trauma patients at the emergency department: A consecutive 363 series from a level I trauma center Effects of COVID-19 lockdown phases in India: an atmospheric perspective Epidemiologic 367 35, In Vivo Orthopaedic Surgery: Experiences from Iran Covid-19 and Domestic Violence: an Indirect Path to Social and 380 Economic Crisis A global 382 analysis of the impact of COVID-19 stay-at-home restrictions on crime. Nat Hum 383 Behav Covid-385 19 orthopedic trauma patients characteristics and management during the first 386 pandemic period: report from a single institution in Italy Time to 388 surgery is associated with thirty-day and ninety-day mortality after proximal femoral 389 fracture: A retrospective observational study on prospectively Danish fracture database collaborators Is operative delay associated with increased mortality of 392 hip fracture patients? Systematic review, meta-analysis, and meta-regression Treatment 395 of Proximal Femoral Fragility Fractures in Patients with COVID-19 During the SARS Impact of 401 the COVID-19 Pandemic on an Managing fragility fractures during the COVID-19 pandemic Don't Neglect Osteoporosis Therapy During COVID-19 Revisiting conservative orthopaedic management of 408 fractures during COVID-19 pandemic COVID-19. An update for orthopedic surgeons Problems in the management of type III 412 (severe) open fractures: a new classification of type III open fractures Pooling of neglected and delayed trauma 415 patients -Consequences of 'lockdown' and 'Unlock' phases of The impact of COVID-19 on trauma 426 and orthopaedic patients requiring surgery during the peak of the pandemic Practical considerations for 429 performing regional anesthesia: lessons learned from the COVID-19 pandemic The role of the orthopaedic 432 surgeon in the COVID-19 era: cautions and perspectives Is performing joint 434 arthroplasty surgery during the COVID-19 pandemic safe?: A retrospective, cohort 435 analysis from a tertiary centre in NCR Recommendations for Surgery During the Novel Coronavirus (COVID-19) Epidemic CoViD-19 and ortho and 451 trauma surgery: The Italian experience Impact of COVID-19 on the practice of orthopaedics 453 and trauma-an epidemiological study of the full pandemic year of a tertiary care centre 454 of New Delhi COVID-19) on the epidemiology of orthopedics trauma in a region of central italy The global burden 459 of trauma during the COVID-19 pandemic: A scoping review COVID-19 Pandemic on Orthopaedic Trauma Volumes: a Multi-Centre Perspective From the State of Telangana Epidemiological pattern of orthopaedic 465 fracture during the COVID-19 pandemic: A systematic review and meta-analysis The authors have no disclosures or conflict if interest to disclose regarding the research or work done for publication of this article.