Examining the 2019 Novel Coronavirus Disease (COVID-19) Pandemic on Traumatic Hip and Lower Extremity Orthopedic Cases: A Systematic Review and Meta-analysis





COVID-19, hip and lower extremity, trauma, surgery


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


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