Lasting Shifts in Musculoskeletal Injuries Across Pre-, During-, and Post-Pandemic Periods: A Propensity Score-Matched Study

Background: COVID-19, a global pandemic, has had a profound impact on the world, overwhelming healthcare systems worldwide. These disruptions were associated with significant disparities in healthcare access to routine consultations and elective surgeries, adversely affecting patient health and altering injury patterns in emergency departments. This retrospective observational study aims to compare patient profiles and treatment during the pandemic compared to the pre-pandemic period. Methods: Patients admitted to the orthopaedic and traumatology department before, during, and after the COVID-19 pandemic. The full (unmatched) cohort comprised 8413 patients (6175 before, 1188 during, and 1050 after the pandemic). To ensure balanced comparisons, propensity score matching (1:2, based on age, sex, and comorbidities) was applied separately to the during- and after-pandemic groups, each matched against pre-pandemic controls. Collected information incorporated demographics, comorbidities, and injury circumstances. Results: After matching, the during-pandemic group (1188 patients) was compared with 2376 pre-pandemic controls, and the after-pandemic group (1050 patients) with 2100 pre-pandemic controls. A higher proportion of same-region re-injuries was observed during and after the pandemic, as well as higher medical leave during the pandemic and post-pandemic, and longer hospital stays of over 10 days during the pandemic and post-pandemic. Injury patterns changed, with an increase in lower leg injuries and a decrease in wrist injuries during the pandemic. Additionally, the proportion of open wounds was lower during the pandemic. Conclusions: The pandemic and post-pandemic periods were associated with marked changes in trauma care, including more conservative treatment, fewer surgeries, and longer hospital stays. Same-region re-injuries were more frequent and sports-related injuries less frequent—patterns that temporally coincided with the periods of repeated lockdowns. Notably, differences persisted into the post-pandemic period. Given the retrospective, observational design, these findings represent associations rather than causal effects.