A New Normal: Trends of Upper Extremity Orthopaedic Injuries Nationwide During the COVID-19 Pandemic

Abstract

Background The widespread societal effects of the COVID-19 pandemic connote public health and epidemiological changes for orthopedic injuries. The epidemiology of upper extremity injuries and the effects of the pandemic on these nationwide trends is poorly defined. Methods This cross-sectional, descriptive epidemiological study compares epidemiological trends among upper extremity (UE) orthopedic injuries presenting to emergency departments (EDs) prior to and during the COVID-19 pandemic. Upper extremity fracture and dislocation data was sourced from the National Electronic Injury Surveillance System (NEISS) database in years prior to (2015-2019) and during the pandemic (2020-2021). Data on incidence, patient demographics, injury patterns, mechanisms of injury, incident locale, and patient disposition were collected and compared between years. Results The pre-COVID-19 incidence rate (IR) of UE fractures at 2.03 per 1,000 persons (n=3038930 from 2015-2019) decreased to 1.84 per 1,000 in 2020 (n=474805) and 1.82 per 1,000 in 2021 (n=471793). Dislocation rates were largely unchanged at 0.34 per 1,000 people (n=476740) prior to the pandemic and with incidence rates of 0.33 per 1,000 (n=85582) and 0.34 per 1,000 (n=89386) in 2020 and 2021, respectively. Female patients over 65 had the highest injury IR at 4.85 per 1,000 (n=976948). Finger fractures (IR=0.38 per 1000, n=96009) overtook hand fractures (IR=0.51 per 1000, n=310710) as more common during COVID-19 in males, while wrist (IR=0.55 per 1000, n=350650) fractures remained most common in females. Injuries from individual sports, such as skateboarding and bicycling, increased during the pandemic, while injuries from team sports decreased. Hospital admission and observation increased in 2020, while discharge and transfer rates decreased. Admission, observation, and discharge rates moved closer to pre-pandemic levels in 2021. Conclusions The COVID-19 pandemic was associated with epidemiological and activity changes regarding UE fractures and dislocations presenting to EDs. The present study demonstrates notable decreases in rates of upper extremity fractures and dislocations, increases in rates of injuries related to outdoor and individual sports such as skateboarding with corresponding decreases in rates of injuries related to organized sports such as basketball, increases in the rates of injuries occurring in homes and in association with pet supplies, and decreases in rates of injuries occurring in schools and places of recreation observed during the pandemic. Additionally, trends observed among patient disposition specific to the pandemic, such as increasing rates of patient admission, observation, and against medical advice (AMA) departure with decreasing rates of discharge and transfer, offer insight into the burden of upper extremity injuries on the healthcare system during this critical time. While upper extremity orthopedic injuries remained common through the pandemic, the early pandemic was associated with higher rates of hospital admission that normalized closer to pre-pandemic levels by 2021, which may herald a shift and return to pre-pandemic trends. Future research will determine the long-term downstream effects of COVID-19 on activity-related orthopedic injuries and bone health.

Keywords: covid-19; emergency medical system; epidemiology; orthopedics; upper extremity injuries; upper extremity trauma.

Figure 1. Incidence of upper extremity injuries per thousand people by year