Where Have All the Fractures Gone? The Epidemiology of Pediatric Fractures during the COVID-19 Pandemic

Background/Purpose: During the COVID-19 pandemic, public health measures to encourage social distancing have been implemented, including cancellation of school and organized sports. A resulting change in pediatric fracture epidemiology is expected. This study examines the impact of the COVID-19 pandemic on fracture incidence and characteristics. Methods: This is a retrospective cohort study comparing acute fractures presenting to a single Level I pediatric trauma hospital during the COVID-19 pandemic to fractures during a pre-pandemic period at the same institution. The “pandemic” cohort was gathered from March 15-April 15, 2020 and compared to a “pre-pandemic” cohort from the same time window in 2018 and 2019. Results: 1,745 patients presenting with acute fractures were included. There was a significant decrease in the incidence of fractures presenting to our practice during the pandemic (22.5±9.1/day vs 9.6±5.1/day, p<0.001). The presenting age for all fractures decreased during the pandemic (7.5±4.3 vs 9.4±4.4 years, p<0.001) due to decreased fracture burden among adolescents. There was also a decrease in the number of fractures requiring surgery (2.2±1.8/day vs 0.8±0.8/day, p<0.001). During the pandemic, there was an increase in the proportion of injuries occurring at home (57.8% vs 32.5%, p<0.001) or on bicycles (18.3% vs 8.2%, p<0.001), but a decrease in those related to sports (7.2% vs 26.0%, p<0.001) or playgrounds (5.2% vs. 9.0%, p<0.001). There was no increase in time-to-presentation. Patients with distal radius torus fractures were more likely to receive a velcro splint during the pandemic (44.2% vs 25.9%, p=0.010). Conclusion: Pediatric fracture volume has decreased 2.5-fold during the COVID-19 pandemic, partially due to cessation of organized sports and decreased playground use. In endemic regions, lower trauma volume may allow redeployment of orthopaedic surgeons and staff to other clinical arenas. Given the rising proportion of bicycling injuries, an emphasis on basic safety precautions could improve public health. An observed increase in prescription of velcro splints for distal radius fractures highlights an opportunity for simplified patient care during the pandemic.