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      Epidemiologic characteristics of traumatic fractures during the outbreak of coronavirus disease 2019 (COVID-19) in China: A retrospective & comparative multi-center study

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          Highlights

          • This retrospective & comparative multi-center study reveals the epidemiological characteristics of traumatic fractures amid the epidemic changes dramatically when compared with normal days. The patients' age, fracture location, osteoporosis fracture, fracture type, severity of trauma, injury mechanism, places where fracture occurred and treatment modality during the epidemic period is very different from that during the non-epidemic period.

          • During the epidemic of COVID-19, the most commonly involving age group was elderly patients, and low-energy injuries (such as slips, falls) were the most prevalent injury mechanism. More attempts should be focused on the prevention of low energy injuries of elderly population.

          • The current study confirmed the importance and effectiveness of the implemented multi-aspect measures to restrict people's movement and wear masks in the prevention of the spread of COVID-19, which could be used as a reference for the public, health care system and health authorities during the global pandemic of COVID-19.

          Abstract

          Purpose

          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.

          Methods

          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.

          Results

          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 2  = 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%).

          Conclusions

          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.

          Related collections

          Most cited references 15

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          Costs and quality of life associated with osteoporosis-related fractures in Sweden.

          This prospective observational data collection study assessed the cost and quality of life related to hip, vertebral and wrist fracture 1 year after the fracture, based on a patient sample consisting of 635 male and female patients surviving a year after fracture. Data regarding resource use and quality of life related to fractures was collected by questionnaires at baseline, 4 months and 12 months. Information was collected by the use of patients' records, register sources and by asking the patient. Quality of life was estimated with the EQ-5D questionnaire. Costs were estimated from a societal perspective, including direct and indirect costs. The mean fracture-related cost the year after a hip, vertebral and wrist fracture were estimated, in euros ( ), at 14,221, 12,544 and 2,147, respectively [converted from Swedish krona (SEK) at an exchange rate of 9.1268 SEK/ ]. The mean reduction in quality of life was estimated at 0.17, 0.26 and 0.06 for hip, vertebral and wrist fracture, respectively. Based on the results, the yearly burden of osteoporosis in Sweden could be estimated at 0.5 billion (SEK 4.6 billion). The patient sample for vertebral fracture was fairly small and included a high proportion of fractures leading to hospitalization, but they indicate a higher cost and loss of quality of life related to vertebral fracture than previously perceived.
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            Is Open Access

            National incidence of traumatic fractures in China: a retrospective survey of 512 187 individuals.

            Traumatic fractures place a substantial burden on health-care systems worldwide. Although detailed information about incidence, distribution, and risk factors for traumatic fractures is vital for planning and prevention, in China, national data are unavailable. We aimed to do an up-to-date national survey on the population-weighted incidence of traumatic fractures in China.
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              Secondary prevention after an osteoporosis-related fracture: an overview.

              This article is an overview of the status of postfracture secondary prevention programs. The concept of fracture risk, the inclusion of fracture risk in clinical practice guidelines for osteoporosis, and how fracture risk has contributed to the development of postfracture secondary prevention programs are described. The scope of postfracture secondary prevention programs, the gaps in care that persist despite these initiatives, and the potential reasons for these gaps are also described. Recommendations for future research in the area of postfracture secondary prevention are provided.
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                Author and article information

                Contributors
                Journal
                Injury
                Injury
                Injury
                Elsevier Ltd.
                0020-1383
                1879-0267
                15 June 2020
                15 June 2020
                Affiliations
                [a ]Editorial department, the Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang 050051, PR China
                [b ]Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University
                Author notes
                [1]

                These authors contributed equally to this work.

                Article
                S0020-1383(20)30522-2
                10.1016/j.injury.2020.06.022
                7295526
                © 2020 Elsevier Ltd. All rights reserved.

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                Categories
                Article

                Emergency medicine & Trauma

                covid-19, epidemic, fracture, epidemiology

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