Staying home during 'COVID-19' decreased fractures, but trauma did not quarantine in one hundred and twelve adults and twenty eight children and the 'tsunami of recommendations' could not lockdown twelve elective operations

摘要

Purpose The current pandemic caused by COVID-19 is the biggest challenge for national health systems for a century. While most medical resources are allocated to treat COVID-19 patients, fractures still need to be treated, as some patients with non-deferrable pathologies. The aim of this paper is to report the early experience of an integrated team of orthopaedic surgeons during this period. Material and methods This is a mono-geographic, observational, retrospective, descriptive study. We collected data from the beginning of the epidemic (1 March 2020), during the pandemic lockdown period (declared in the country on March 16, 2020) until the end of our study period on April 15, 2020. All the 140 patients presented to the Emergency Department of the hospital during this period with a diagnosis of fracture, or trauma (sprains, dislocations, wounds) were included in the cohort. In addition, 12 patients needing hospitalization for planning a non-deferrable elective surgical treatment were included. A group of patients from the two same hospitals and treated during the same period (1(st) March 2018 to April 15, 2018) but previously was used as control. Results Of these 152 patients (mean age 45.5 years; range 1 to 103), 100 underwent a surgical procedure and 52 were managed non-operatively. Twenty-eight were children and 124 were adults. The COVID-19 diagnosis was confirmed for four patients. The frequency of patients with confirmed COVID-19 diagnosis among this population treated in emergency was ten fold higher (2.6%; 4 among 152) than in the general population (0.30%) of the country. The mortality rate for patients with surgery was 2% (2 of 100 patients) and 50% (2 of 4) for those older than 60 years with COVID-19; it was null for patients who were managed non-operatively. As compared to the year 2018, the number of patients seen with trauma had decreased of 32% during the epidemic. Conclusion Staying home during the COVID-19 pandemic decreased trauma frequency of 32%. The structural organization in our hospital allowed us to reduce the time to surgery and ultimately hospital stay, thereby maximizing the already stretched medical resources available to treat all the patients who needed orthopedic care during this period.