The impact of COVID-19 on shoulder and elbow trauma. An Italian survey

Gumina, Stefano; Proietti, Riccardo; Polizzotti, Giuseppi; Carbone, Stefano; Candela, Vittorio

Abstract Background Because of the rapid spreading of COVID-19, on March 8th, Italy became a "protected area": people are told not to leave their homes unless for an essential reason. Aim of this study was to evaluate the activity of our Trauma Centre, relative to shoulder and elbow, in 30 days starting from March 8th, 2020, the first day of restrictions in Italy, and to compare it with the same days of 2019 to weight the impact of Covid-19 on the shoulder and elbow trauma. Materials and methods Patients managed in our Trauma Centre between 8th March 2020 and 8th April 2020 (COVID-19 period) for a shoulder and elbow trauma were retrospectively included and compared to patients admitted in the same period of 2019 (no COVID-19 period).Clinical records of all participants were examined to obtain information regarding age, sex, mechanism of injury, diagnosis. Results During no COVID-19 period, 133 patients were admitted for a shoulder or elbow trauma; in the COVID period, patients were 47(65% less first aid). In the no-COVID and COVID period, patients with shoulder contusion were 60 (14.78% of all) (M:34; F:26) (mean age: 51.8yrs; range: 18-88) and 11 (12.09% of all contusions) (M:7; F:4) (mean age: 43yrs; range: 24-60), respectively. In the no-COVID period, 27 fractures (9.34% of all fractures) involved the shoulder, while 18 fractures (8.69%) were registered in the COVID period. In the no-COVID period,14 elbow fractures were treated (4.8% of all fractures), and 4 in the COVID period. In the no-COVID and COVID periods, 6 (M:5; F:1) (mean age: 42yrs; range 21-64) and 2 (M: 1; F: 1) (mean age: 29.5yrs; range: 24-35 ) patients reported having the feeling of momentary post-traumatic shoulder instability; at the elbow, patients were 0 and 1 (M: 1; F: 0) (age: 56yrs), respectively. Finally, first or recurrent dislocations in the no-COVID period were 10 and 7 in the COVID period.; in the no-COVID period, elbow dislocations were 2, and 3 in the COVID-period. Conclusions During the COVID period, we provided a reduced number of health services, especially for patients with low energy trauma and for those who underwent sports and traffic accidents. However, during the COVID period, elderly subjects remain exposed to shoulder and elbow trauma due to low-energy (domestic) falls. The subsequent hospitalization of these patients has contributed to making more difficult the management of the hospital wards, partly occupied by COVID-19 patients.