Editorial department, the Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang 050051, PR China.
Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University.
Injury. 2020 Aug;51(8):1698-1704. doi: 10.1016/j.injury.2020.06.022. Epub 2020 Jun 15.
Amid the outbreak of coronavirus disease 2019 (COVID-19), effective measures have been taken in China to suggest people wearing masks and staying at home. The majority of the people stayed at home, which had an obvious impact on the occurrence of traumatic fractures. This study aimed to describe the epidemiologic characteristics of traumatic fractures during the COVID-19, and provide reference for targeted control measures for the whole world by proposing China's experiences.
This was a retrospective & comparative multi-center study with data obtained from 11 hospitals in five provinces of China. Patients were enrolled into this study, who sustained fractures from 20 January to 19 February 2020 and the same period in 2019 (based on Chinese lunar calendar). All patients were divided into two groups: epidemic group (admitted in 2020) and control group (admitted in 2019). The data of patients' demographics (age and gender), injury related data (fracture type, fractured site, osteoporosis fracture, concurrent fractures, injury mechanism, places where fracture occurred, ISS score, Gustilo-Anderson Classification for open fracture), mortality and treatment modality were compared between the two groups.
A total of 2,489 patients with 2,590 fractures were included. In the epidemic group, there were 865 patients, including 483 (55.8%) males and 382 (44.2%) females with an average age of 53.1 ± 23.1 years (range, 1 to 105). In the control group, there were 1,624 patients, including 876 (53.9%) males and 748 (46.1%) females with an average age of 51.2 ± 21.5 years (range, 1 to 98). Patients in the epidemic group was significantly older than those in the control group (t=-2.046, P = 0.045). For epidemic group, the mostly commonly involved age group was elderly patients, whereas it was middle-aged adults for the control group (χ = 14.642, P = 0.002). For epidemic group, a total of 576 (66.6%) patients had their fracture occurring at home, while in the control group there was 183 (11.3%). The proportion rates of low energy injuries (79.1%, 684/865), osteoporotic fractures (32.5%, 294/906) and closed fractures (94.5%, 817/865) in the epidemic group were significantly higher when compared to the control group, respectively (34.4%, 559/1624; 26.9%, 453/1684; 91.9%, 1,493/1692; all P<0.05). The proportion rates of Gustilo-Anderson classification (5.5%, 16/865), concurrent fractures (2.3%, 20/865), and injury severity score (15.6 ± 6.7) in epidemic group were significantly lower than those in the control group, respectively (52.8%, 199/1624; 3.9%, 63/1624; 20.1 ± 8.7; all P<0.05). No positive case with COVID-19 was diagnosed in the epidemic group. The mortality rate in the epidemic group (0.46%) was similar with that in the control group (0.43%).
Our findings confirmed the importance of the measures to restrict people's movement and wear masks in the prevention of the spread of COVID-19. The epidemiological characteristics of traumatic fractures amid the epidemic changes dramatically, and more attempts should be focused on the prevention of low energy injuries of elderly population.
在 2019 年冠状病毒病（COVID-19）爆发期间，中国采取了有效措施，建议人们戴口罩和居家。大多数人都待在家里，这对创伤性骨折的发生有明显影响。本研究旨在描述 COVID-19 期间创伤性骨折的流行病学特征，并通过提出中国的经验，为全球提供有针对性的控制措施提供参考。
这是一项回顾性对比多中心研究，数据来自中国五个省的 11 家医院。纳入 2020 年 1 月 20 日至 2 月 19 日和 2019 年同期（基于中国农历）因骨折入院的患者。所有患者分为两组：疫情组（2020 年入院）和对照组（2019 年入院）。比较两组患者的人口统计学数据（年龄和性别）、损伤相关数据（骨折类型、骨折部位、骨质疏松性骨折、合并骨折、损伤机制、骨折发生地点、ISS 评分、Gustilo-Anderson 开放性骨折分类）、死亡率和治疗方式。
共纳入 2489 例患者，2590 处骨折。在疫情组中，有 865 例患者，其中 483 例（55.8%）为男性，382 例（44.2%）为女性，平均年龄 53.1±23.1 岁（范围 1-105）。在对照组中，有 1624 例患者，其中 876 例（53.9%）为男性，748 例（46.1%）为女性，平均年龄 51.2±21.5 岁（范围 1-98）。疫情组患者明显比对照组患者年龄大（t=-2.046，P=0.045）。对于疫情组，最常见的年龄段是老年患者，而对照组则是中年成年人（χ²=14.642，P=0.002）。在疫情组中，共有 576 例（66.6%）患者的骨折发生在自己家中，而对照组则有 183 例（11.3%）。疫情组低能量损伤（79.1%，684/865）、骨质疏松性骨折（32.5%，294/906）和闭合性骨折（94.5%，817/865）的比例明显高于对照组，分别为 34.4%（559/1624）、26.9%（453/1684）和 91.9%（1493/1692）（均 P<0.05）。疫情组 Gustilo-Anderson 分类（5.5%，16/865）、合并骨折（2.3%，20/865）和损伤严重程度评分（15.6±6.7）的比例明显低于对照组，分别为 52.8%（199/1624）、3.9%（63/1624）和 20.1±8.7（均 P<0.05）。在疫情组中未诊断出 COVID-19 阳性病例。疫情组的死亡率（0.46%）与对照组相似（0.43%）。
我们的研究结果证实了限制人们的行动和戴口罩等措施在 COVID-19 传播中的重要性。疫情期间创伤性骨折的流行病学特征发生了巨大变化，应更加关注老年人群的低能量损伤预防。
