Examining the 2019 Novel Coronavirus Disease (COVID-19) Pandemic on Traumatic Hip and Lower Extremity Orthopedic Cases: A Systematic Review and Meta-analysis
DOI:
https://doi.org/10.31282/joti.v5n1.85Keywords:
COVID-19, hip and lower extremity, trauma, surgeryAbstract
Background: The 2019 novel coronavirus disease (COVID-19) pandemic made a significant impact on daily
traumatic orthopedic practice. Specifically, recent studies reported a notable reduction in traumatic hip and lower
extremity orthopedic case admission. This study aims to examine the impact of the COVID-19 pandemic on
traumatic hip and lower extremity orthopedic cases and surgery compared to the pre-pandemic period.
Methods: A systematic literature search was conducted through PubMed, ScienceDirect, and Cochrane Library,
published up to January 2022 following the PRISMA guideline. We assessed the study quality using the NewcastleOttawa scale (NOS). The primary outcome analyzed in this study was traumatic hip and lower extremity admission
case number and surgical case number, both measured as risk ratio (RR) with 95% confidence intervals (CIs).
The analysis was performed using Review Manager 5.4 and STATA 17.
Results: A total of 17 studies met the inclusion criteria for the analysis. The overall analysis reported an estimated
52.7% reduction in traumatic hip and lower extremity admission during the COVID-19 pandemic, which was
indicated by our pooled analysis (RR 0,89, 95% CI 0.82, 0.96, p=0.002). Meanwhile, there is no significant
difference for the surgical cases (RR 1.01, 95% CI 0.94, 1.08, p=0.80). Egger’s test result showed no evidence
of small-study effects (p=0.22).
Conclusion: This study showed that traumatic hip and lower extremity admission significantly decreased during
the pandemic period compared to the pre-pandemic period. Meanwhile, the surgical case was not significantly
affected
Downloads
References
Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, Zhao X, Huang B, ShiW, LuR, NiuP, ZhanF, Ma X, Wang D, Xu W, Wu G, Gao GF, Tan W (2020) China novel coronavirus investigating and re- search team. A novel coronavirus from patients with pneumonia in China. N Engl J Med 382(8):727–733
COVID-19 Map [Internet] (2020) Johns Hopkins Coronavirus Resource Center. [cited 7 June 2020]. Available from: https:// coronavirus.jhu.edu/map.html
Wang LS, Wang YR, Ye DW, Liu QQ. A review of the 2019 Novel Coronavirus (COVID-19) based on current evidence”. Int J Antimicrob Agents. 2020 Mar;19: 105948. https://doi.org/10.1016/j.ijantimicag.2020.105948.
Li Q, Guan X, Wu P, Wang X, Zhou L, Tong Y, et al. Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. N Engl J Med 2020;.
Vaughan A. Italy in lockdown. New Sci 2020;245(3273):7.
Décret n° 2020–293 du 23 mars 2020 prescrivant les mesures générales nécessaires pour faire face à l’épidémie de covid-19 dans le cadre de l’état d’urgence sanitaire
Gregory TM, Bihel T, Guigui P et al (2016) Terrorist attacks in Paris: surgical trauma experience in a referral center. Injury 47: 2122–2126. https://doi.org/10.1016/j.injury.2016.08.014
Ministère des solidarités et de la santé (2020) Préparation à la phase épidémique de Covid-19. Établissements de santé Médecine de ville Établissements et services médico-sociaux. Guide Méthodologique
Sarac NJ, Sarac BA, Schoenbrunner AR et al (2020) A review of state guidelines for elective orthopedic procedures during the COVID-19 outbreak. J Bone Joint Surg Am 0(0):1–4. https://doi. org/10.2106/JBJS.20.00510
DePhillipo NN, Larson CM, O’Neill OR, LaPrade RF (2020) Guidelines for ambulatory surgery centers for the care of surgically necessary/time-sensitive orthopedic cases during the COVID-19 pandemic. J Bone Joint Surg Am 0(0):1–4. https://doi.org/10.2106/ JBJS.20.00489
Ghogawala Z, Kurpad S, Falavigna A et al (2020) Editorial. COVID-19 and spinal surgery. J Neurosurg Spine:1–3. https:// doi.org/10.3171/2020.4.SPINE20468
Nuñez JH, Sallent A, Lakhani K, Guerra-Farfan E, Vidal N, Ekhtiari S and Minguell J: Impact of the COVID-19 Pandemic on an Emergency Traumatology Service: Experience at a tertiary trauma centre in Spain. Injury 51(7): 1414-1418, 2020. PMID: 32405089. DOI: 10.1016/j.injury.2020.05.016
Benazzo F, Rossi SMP, Maniscalco P, Moretti B, Vaienti E, Ruggieri P, et al (2020) The orthopedic and traumatology scenario during Covid-19 outbreak in Italy: chronicles of a silent war. Int Orthop. 2020 Aug;44(8):1453-1459. doi: 10.1007/s00264-020-04637-3. Epub 2020 Jun 26. PMID: 32591960; PMCID: PMC7319215.
Lubbe RJ, Miller J, Roehr CA, Allenback G, Nelson KE, Bear J, Kubiak EN. Effect of Statewide Social Distancing and Stay-At-Home Directives on Orthopedic Trauma at a Southwestern Level 1 Trauma Center During the COVID-19 Pandemic. J Orthop Trauma. 2020 Sep;34(9):e343-e348. doi: 10.1097/BOT.0000000000001890. PMID: 32815849; PMCID: PMC7446999.
Dhillon MS, Kumar D, Saini UC, Bhayana H, Gopinathan NR, Aggarwal S. Changing Pattern of Orthopedic Trauma Admissions During COVID-19 Pandemic: Experience at a Tertiary Trauma Centre in India. Indian J Orthop. 2020 Aug 28;54(Suppl 2):374-379. doi: 10.1007/s43465-020-00241-0. PMID: 32873987; PMCID: PMC7453127.
Zhu W, Yang J, Xu L, Fang S. A plunge in the number of traumatic traffic injuries in an emergency center in Anhui province, China. Am J Emerg Med. 2020 Oct;38(10):2230-2231. doi: 10.1016/j.ajem.2020.03.027. Epub 2020 Mar 20. PMID: 32222316; PMCID: PMC7270509.
Park C, Sugand K, Nathwani D, Bhattacharya R, Sarraf KM. Impact of the COVID-19 pandemic on orthopedic trauma workload in a London level 1 trauma center: the "golden month". Acta Orthop. 2020 Oct;91(5):556-561. doi: 10.1080/17453674.2020.1783621. Epub 2020 Jun 23. PMID: 32573331; PMCID: PMC8023929.
Giuntoli, Michele, Enrico Bonicoli, Giulia Bugelli, Massimo Valesini, Mario Manca and Michelangelo Scaglione. “Lessons learnt from COVID 19: An Italian multicentric epidemiological study of orthopaedic and trauma services.” Journal of Clinical Orthopaedics and Trauma 11 (2020): 721 - 727.
Poggetti A, Del Chiaro A, Nucci AM, Suardi C, Pfanner S. How hand and wrist trauma has changed during covid-19 emergency in Italy: Incidence and distribution of acute injuries. What to learn? J Clin Orthop Trauma. 2021 Jan;12(1):22-26. doi: 10.1016/j.jcot.2020.08.008. Epub 2020 Sep 9. PMID: 32921952; PMCID: PMC7480256.
Bram JT, Johnson MA, Magee LC, et al. Where have all the fractures gone? The epidemiology of pediatric fractures during the COVID-19 pandemic. J Pediatr Orthop. 2020;40(8):373e379.
Luengo-Alonso G, Pérez-Tabernero FG, Tovar-Bazaga M, Arguello-Cuenca JM, Calvo E. Critical adjustments in a department of orthopaedics through the COVID-19 pandemic. Int Orthop. 2020 Aug;44(8):1557-1564. doi: 10.1007/s00264-020-04647-1. Epub 2020 May 30. PMID: 32474718; PMCID: PMC7260474.
Andreozzi V, Marzilli F, Muselli M, Previ L, Cantagalli MR, Princi G, Ferretti A. The impact of COVID-19 on orthopaedic trauma: A retrospective comparative study from a single university hospital in Italy. Orthop Rev (Pavia). 2021 Jan 28;12(4):8941. doi: 10.4081/or.2020.8941. PMID: 33585026; PMCID: PMC7874950.
Hampton M, Clark M, Baxter I, Stevens R, Flatt E, Murray J, Wembridge K. The effects of a UK lockdown on orthopaedic trauma admissions and surgical cases: A multicentre comparative study. Bone Jt Open. 2020 Jul 21;1(5):137-143. doi: 10.1302/2633-1462.15.BJO-2020-0028.R1. PMID: 33241224; PMCID: PMC7684391.
Heaps BM, Ladnier K, Haselman WT, Limpisvasti O, Banffy MB. Epidemiologic impact of COVID-19 on a multi-subspecialty orthopaedic practice. J Orthop. 2021 May-Jun;25:151-154. doi: 10.1016/j.jor.2021.05.011. Epub 2021 May 6. PMID: 33972818; PMCID: PMC8099547.
Hernigou J, Morel X, Callewier A, Bath O, Hernigou P. Staying home during "COVID-19" decreased fractures, but trauma did not quarantine in one hundred and twelve adults and twenty eight children and the "tsunami of recommendations" could not lockdown twelve elective operations. Int Orthop. 2020 Aug;44(8):1473-1480. doi: 10.1007/s00264-020-04619-5. Epub 2020 May 25. PMID: 32451655; PMCID: PMC7247744.
Karia M, Gupta V, Zahra W, Dixon J, Tayton E. The effect of COVID-19 on the trauma burden, theatre efficiency and training opportunities in a district general hospital: planning for a future outbreak. Bone Jt Open. 2020 Aug 18;1(8):494-499. doi: 10.1302/2633-1462.18.BJO-2020-0074.R1. PMID: 33215144; PMCID: PMC7659630.
Lubbe RJ, Miller J, Roehr CA, Allenback G, Nelson KE, Bear J, Kubiak EN. Effect of Statewide Social Distancing and Stay-At-Home Directives on Orthopaedic Trauma at a Southwestern Level 1 Trauma Center During the COVID-19 Pandemic. J Orthop Trauma. 2020 Sep;34(9):e343-e348. doi: 10.1097/BOT.0000000000001890. PMID: 32815849; PMCID: PMC7446999.
Luceri F, Morelli I, Accetta R, Mangiavini L, Maffulli N, Peretti GM. Italy and COVID-19: the changing patient flow in an orthopedic trauma center emergency department. J Orthop Surg Res. 2020 Aug 14;15(1):323. doi: 10.1186/s13018-020-01816-1. PMID: 32795347; PMCID: PMC7426894.
Frink M, Ketter V, Klama N, Knauf T, Betz S, Ruchholtz S, Aigner R. Effect of coronavirus (COVID-19) pandemic on orthopedic trauma patients presenting in the emergency department of a maximum care hospital and level 1 trauma center. Arch Orthop Trauma Surg. 2021 Nov 9:1–6. doi: 10.1007/s00402-021-04234-y. Epub ahead of print. PMID: 34751810; PMCID: PMC8576456.
Mitkovic MM, Bumbasirevic M, Milenkovic S, Gajdobranski D, Bumbasirevic V, Mitkovic MB. Influence of coronavirus disease 2019 pandemic state of emergency in orthopaedic fracture surgical treatment. Int Orthop. 2021 Apr;45(4):815-820. doi: 10.1007/s00264-020-04750-3. Epub 2020 Jul 29. PMID: 32728928; PMCID: PMC7389160.
Maryada VR, Mulpur P, Guravareddy AV, Pedamallu SK, Vijay Bhasker B. Impact of COVID-19 Pandemic on Orthopaedic Trauma Volumes: a Multi-Centre Perspective From the State of Telangana. Indian J Orthop. 2020 Aug 13;54(Suppl 2):368-373. doi: 10.1007/s43465-020-00226-z. PMID: 32836367; PMCID: PMC7423500.
Ribau A, Vale J, Xará-Leite F, Rodrigues-Pinto R. Impact of COVID-19 pandemic and national lockdown in an orthopaedic and traumatology department-a comparison with the homologous period of 2019. Porto Biomed J. 2021 Jan 18;6(1):e109. doi: 10.1097/j.pbj.0000000000000109. PMID: 33490702; PMCID: PMC7817277.
Sugand K, Park C, Morgan C, Dyke R, Aframian A, Hulme A, Evans S, Sarraf KM, Baker C, Bennett-Brown K, Simon H, Bray E, Li L, Lee N, Pakroo N, Rahman K, Harrison A. Impact of the COVID-19 pandemic on paediatric orthopaedic trauma workload in central London: a multi-centre longitudinal observational study over the "golden weeks". Acta Orthop. 2020 Dec;91(6):633-638. doi: 10.1080/17453674.2020.1807092. Epub 2020 Aug 24. PMID: 32835573; PMCID: PMC8023947.
Waghmare, Antariksh & Shrivastava, Sandeep & Date, Swapnil. (2020). Effect of Covid-19 lockdown in trauma cases of Rural India. International Journal of Research in Pharmaceutical Sciences. 11. 365-368. 10.26452/ijrps.v11iSPL1.2727.
Wong FL, Antoniou G, Williams N, Cundy PJ. Disruption of paediatric orthopaedic hospital services due to the COVID-19 pandemic in a region with minimal COVID-19 illness. J Child Orthop. 2020 Aug 1;14(4):245-251. doi: 10.1302/1863-2548.14.200140. PMID: 32874355; PMCID: PMC7453176.
Yu P, Wu C, Zhuang C, Ye T, Zhang Y, Liu J, Wang L. The patterns and management of fracture patients under COVID-19 outbreak in China. Ann Transl Med. 2020 Aug;8(15):932. doi: 10.21037/atm-20-4174. PMID: 32953732; PMCID: PMC7475431.
