The trend of fracture distribution in the SARS-CoV-2 era: organization and resource allocation in a level I trauma care center
Fabrizio Matassi, Niccolò Giabbani, Giacomo Sani, Lorenzo Ius, Francesco Raspanti, Alberto Galeotti, Matteo Innocenti, Luigi Zanna, Carlo Rostagno, Roberto Civinini
Purpose: This study analyzes changes in the epidemiology of fractures during the SARS-CoV-2 era. Its aim was to better understand the workload of the orthopedic department, as well as the management of healthcare professionals, in this situation, with a view to ensuring optimal resource allocation in the event of any future epidemic emergency.
Methods: Admissions to the orthopedic emergency room for trauma care were analyzed with reference to the period January 2019 to April 2020. The rate of hospitalized patients (group A) and the rate of patients discharged pending delayed surgery (group B) were recorded. Furthermore, distribution of the various fracture types, and of different trauma dynamics, was also evaluated.
Results: The data show a reduction in the number of total admissions (from an average of 70.92/day to 21.15/day during the COVID period). In the pre-COVID era, patients requiring hospitalization accounted for 7.01% of all admissions; this rate increased to 12.47% in March 2020 and 15.67% in April 2020. No increase was found in the rate of patients assigned to delayed surgery: 1.31% in the pre COVID-era, 1.11% in March 2020, and 0.70% in April 2020. The frequency of proximal femoral fractures remained stable (53.71/month in the pre-COVID era, 47.5/month in the COVID era), while high-energy fractures decreased during the outbreak.
Conclusion: During epidemics such as the SARS-CoV-2 outbreak, trauma services must be guaranteed in order to treat fractures and orthopedic emergencies, while elective procedures should be discontinued to preserve resources and allow conversion of professionals in order to meet ICU needs. The epidemiology of fractures can change, but orthopedists must still ensure high quality of care and, at the same time, protect themselves and their patients from the risk of viral infection.
