The impact of COVID-19 on shoulder and elbow trauma in skeletally immature population. An Italian survey

Gumina, S.; Proietti, R.; Villani, C.; Carbone, S.; Candela, V.

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.