Introduction
Methods
Eligibility criteria
Search strategy
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P (Population): Orthopaedic and Trauma patients;
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I (Intervention): Patient management;
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C (Comparison): 2020 versus 2019;
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O (Outcomes): consultations and surgeries, sports medicine, fragility fractures, trauma registries;
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S (Source): European Orthopaedic and Trauma centres
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T (Type of study): clinical investigation.
Selection and data collection
Results
Search results
Results syntheses
Author, year | Journal | Design | Country | Main findings |
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Andreata et al., 2020 [35] | Int Orthop | Retrospective | Italy | These data clearly show the deep impact of the Covid-19 pandemic on OR facilities. Efficiency indicators fell dramatically in April 2020 compared with the corresponding period in 2019. This scenario will deeply affect both the waiting lists and the economic burden of the hospital. Regaining efficiency and maintaining the quality and safety of the process while restoring elective orthopaedic surgery are among the main challenges that surgeons will face in the next time |
Benazzo et al., 2020 [15] | Int Orthop | Observational | Italy | Covid-19 outbreak showed a tremendous impact on all orthopaedic trauma activities throughout the country except for the surgical treatment of femoral neck fractures, which, although reduced, did not change in percentage within the analyzed timeframe |
Druel et al., 2020 [30] | Int Orthop | Retrospective | France | Containment measures had a direct impact on trauma surgery activity with a decrease of a third of trauma surgery activity. Those results could be useful if a new pandemic occurred |
Ghermandi et al., 2020 [32] | Eur Rev Med Pharmacol Sci | Retrospective Observational | Italy | Surgical activity was paradoxically increased during SARS-CoV-2 pandemic lockdown through the management of urgent and non-deferrable spinal disease with a low rate (3,9%) of Covid-19 infections |
Giuntoli et al., 2020 [23] | J Clin Orthop Trauma | Retrospective | Italy | The Covid-19 pandemic raised many important issues, such as the optimal management of patients requiring the treatment of conventional diseases during a pandemic. The flow of patients changes from one area to another during a pandemic and an integrated approach within the same geographical area could be useful to better allocate resources and manage the patients' needs. The preventive measures put in place in Italy seemed to work, but this first experience with Covid-19 crisis highlighted the chronic problems of the Italian health system and the authors believe that all have to "learn the lesson" to be better prepared in the future |
Greenhalgh et al., 2020 [18] | Int J Clin Pract | Retrospective | UK | The Covid-19 pandemic has had a profound effect of the provision of trauma and orthopaedic surgery. The authors report a significant decrease in all orthopaedic referrals during the pandemic, leading to a greatly reduced number of trauma operations performed. This has allowed for reallocation of staff and resources. The authors suggest that a plan for the lifting of social restrictions be made, since this lifting may lead to an increase in patients presenting with trauma requiring operative intervention |
Gumina et al., 2020 [28] | J Shoulder Elbow Surg | Case Series | Italy | During the Covid-19 period, we provided a reduced number of health services, especially for patients with low-energy trauma and for those who underwent sports and traffic accidents. However, during the Covid-19 period, elderly subjects remain exposed to shoulder and elbow trauma due to low-energy (domestic) falls. The subsequent hospitalization of these patients has contributed to making it more difficult to manage the hospital wards that are partly occupied by Covid-19 patients |
Gumina et al., 2021 [25] | JSES Int | Retrospective | Italy | The pandemic forced us to become aware of the ways and places where skeletally immature subjects report shoulder and elbow traumas; therefore, it would be desirable that more considerable attention be directed toward the prevention of injury in areas at risk |
Hernigou et al., 2020 [34] | Int Orthop | Retrospective Observational | Belgium | Staying home during the Covid-19 pandemic decreased trauma frequency of 32%. The structural organization in our hospital allowed us to reduce the time to surgery and ultimately hospital stay, thereby maximizing the already stretched medical resources available to treat all the patients who needed orthopedic care during this period |
Luceri et al., 2020 [26] | J Orthop Surg Res | Retrospective | Italy | Social isolation certainly reduced the risk of trauma among the general population, and the fear of contagion probably kept non-urgent patients away from the emergency department. Evidence-based programs are fundamental to identify new strategies to maximize National Health System resources and decrease the time which patients spend in the emergency department, reducing overcrowding |
Luengo-Alonso et al., 2020 [22] | Int Orthop | Single-Centre Cross-sectional | Spain | Detailed protocols should be standardized for surgical departments during the pandemic. This paper offers a general view in how this virus affects an orthopaedic unit and could serve as a protocol and example for orthopaedic and trauma units. Even in the worst scenario, an orthopaedic and trauma unit could offer an effective, efficient, and quality service. SARS-CoV-2 will set up a new paradigm for health care in orthopaedics and trauma |
Maniscalco et al., 2020 [29] | Acta Biomed | Retrospective | Italy | In the first two months of the Italian epidemic, in the cities of Piacenza and Parma over 80% of deaths have occurred in patients over 70 years old. Even if preliminary, our study shows a significant increase in death in elderly patients surgically treated for proximal femur fractures, particularly in the Piacenza Hospital |
Mitkovic et al., 2020 [33] | Int Orthop | Retrospective | Serbia | Restricted going outside the home for 54 days has the influence in total number of fractures and gender distribution in femoral neck fractures. The method of external fixation used could be assumed as a reducing factor of intraoperative virus pandemic propagation among medical staff |
Murphy et al., 2020 [31] | Injury | Retrospective | UK | An association between the outbreak of the pandemic and a reduction in referral numbers to our department has been demonstrated. The direct cause of this may be multifactorial but proposing that it is, in part, due to the social distancing measures introduced by the government is certainly conceivable. The patterns of injury would reflect this also with low energy and fragility trauma persisting whilst injuries associated with younger people have reduced. We would suggest that information such as this could be useful in healthcare planning and resource allocation in future pandemic situations |
Nunez et al., 2020 [16] | Injury | Retrospective Observational | Spain | While most traumatological presentations decreased in frequency over the course of the outbreak, the number of osteoporotic hip fractures remained stable. Thus, contingency plans in times of crisis need to be carefully targeted, and to keep in mind certain public health issues that do not decrease, despite a State of Emergency, like osteoporotic hip fractures |
ORCA Collaboration, 2020 [20] | Surgeon | Survey-based | UK | We found a 97% reduction in elective operating, 64% reduction in elective outpatient activity and 37% reduction in operative trauma. 58% of trainees continued working in T&O clinics, with an average of 6 operative cases over this period. Our modelling suggests that the impact on training will persist; counter-measures must be incorporated into central recovery planning |
Park et al., 2020 [21] | Acta Orthop | Longitudinal Observational | UK | The impact of the Covid-19 pandemic has led to a decline in the number of acute trauma referrals, admissions (but increased risk and odds ratio), operations, and aerosolizing anesthetic procedures since implementing social distancing and lockdown measures during the "golden month." |
Peiro-Garcia et al., 2020 [24] | J Child Orthop | Retrospective Observational | Spain | According to our results, the pandemic has significantly affected our daily practice by decreasing elective surgeries and onsite clinics, but other activities have increased. As we have implemented telemedicine and new technologies to adapt to this setback, we should take advantage of the situation to change our practice in the future to better allocate our health resources and to anticipate outbreaks |
Poggetti et al., 2020 [17] | J Clin Orthop Trauma | Retrospective | Italy | Even during drastic movement restrictions and the prolonged suspension of work and leisure activities secondary to Covid-19 epidemic in 2020, hand and wrist traumas rate remained almost the same compared to the same period of the previous year. Nevertheless, a significant change in the etiology and patient age was registered. In fact, sport and traffic-related traumas decreased respect to domestic traumas, while the previous prevalent involvement of young adults was surpassed by accidental hand traumas in the elderly and active adults |
Ruggieri et al., 2020 [37] | J Orthop Surg Res | Retrospective | Italy | Extensive swab test of all people (even if asymptomatic) and proactive tracing and quarantining of potential Covid-19 positive patients may diminish the virus spread |
Staunton et al., 2020 [36] | Surgeon | Retrospective | Ireland | The majority of trauma referred to our Dublin based centre during Covid-19 related population restrictions appears to be home based and trauma volumes have decreased. Significant reductions are apparent in work and sport related injuries suggestive of compliance with Covid-19 activity guidelines. Maintaining existing standards of treatment requires dedicated planning |
Susgand et al., 2020 [19] | Acta Orthop | Retrospective | UK | The majority of trauma referred to our Dublin based centre during Covid-19 related population restrictions appears to be home based and trauma volumes have decreased. Significant reductions are apparent in work and sport related injuries suggestive of compliance with Covid-19 activity guidelines. Maintaining existing standards of treatment requires dedicated planning |
Tamburelli et al., 2020 [39] | J Orthop | Retrospective | Italy | A 50% reduction of surgical procedures during the last three months was observed compared with the same period of time in 2019. The compliance with the containment rules for the spread of the infection, were sufficient to allow safe surgical activity for the medical teams and patients |
von Dercks et al., 2020 [27] | Orthopade | Retrospective | Germany | The measures taken by the Government are an important pillar for the economic security of German hospitals. The lack of differentiation of measures by specialty leads to insufficient compensation for orthopaedics and trauma surgery |
Zagra et al., 2020 [38] | Int Orthop | Retrospective | Italy | These numbers show the radical changed scenario in an orthopaedic center in Milan during Covid-19 pandemic. Elective surgery declined rapidly going close to zero, outpatient admissions were restricted to cases that cannot be postponed, while emergencies increased due to the role played by the hospital as referral orthopaedic centre during the pandemic. The still ongoing emergency will have important impacts on the overall orthopaedic healthcare management for the next months |
Author, year | Journal | Design | Country | Main findings |
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Adiamah et. Al, 2021 [41] | Eur J Trauma Emerg Med | Retrospective cohort | UK | During the SARS-CoV-2 pandemic and the associated national lockdown there was a significant reduction in number of trauma admissions. Patients admitted during the Covid-19 pandemic were older, frailer, more co-morbid and had an associated increased risk of mortality |
Azbel et al., 2021 [44] | BMC Emerg Med | Retrospective cohort | Finland | The societal restrictions imposed by the Finnish government to curb the spread of Covid-19 had a significant effect on the number of EMS calls related to trauma in the capital area. The number of injured patients intoxicated by alcohol decreased significantly and the decrease was temporally related to the lockdown which included the closure of bars and nightclubs |
Esteban et al. 2020 [45] | Bone Join Open | Retrospective | Spain | A marked drop in the total number of visits to our traumatology ED was observed, as well as a relative increase in major injury visits and a relative fall in the minor ones |
Giudici et al., 2021 [46] | World J Emerg Med | Retrospective cohort | Italy | The emergency lockdown during the Covid-19 pandemic in Lombardia led to a reduction of major trauma, especially road-related injuries. The number of patients with intentional injuries admitted to the active level 1 trauma centers was greatly increased during the lockdown and this result would merit further analysis to assess the role of pre-existing factors and their interaction with the imposed restrictions. An increase in centralization to fewer facilities with high level of care obtained satisfactory results in the capability of the health system to take care of trauma emergencies while Covid-19 patients overwhelmed resources of most hospitals |
Hakkenbrak et al., 2021 [42] | Scand J Trauma Resusc Emerg Med | Retrospective cohort | Netherlands | The overall in-hospital healthcare consumption was only marginally reduced and the number of surgically treated patients relatively increased. More severely injured patients and a higher percentage of patients in need for hospital admission were observed. Higher percentages of patients were treated surgically for extremity injuries. Results of this study can be used to optimize the use of hospital capacity and anticipate health care planning in future outbreaks for trauma patients |
Helen et al., 2021 [47] | Swiss Medical Weekly | Retrospective cohort | Switzerland | In the first year of the Covid-19 pandemic, fewer patients with major trauma were admitted to the institution. However, the patients admitted were more severely injured and more often died within 30 days |
Kreis et al., 2021 [43] | Eur J Trauma Emerg Sur | Retrospective cohort | Germany | This analysis shows a decrease of total patient numbers in an emergency department of a Level I trauma centre and a decrease of the total number of operations during the shutdown period. Furthermore, trauma mechanism changed with less traffic, work and sports related accidents |
Moyer et al., 2021 [48] | Scand J Trauma Resusc Emerg Med | Retrospective cohort | France | During the Covid-19 pandemic period and more specifically during lockdown, the study demonstrated a 50% reduction in road traffic accidents with no increase in alternative injury mechanisms, such as assault or suicide. The in-hospital observed and predicted mortality and a number of crucial process indicators remained stable compared to previous years suggesting a sufficient resilience of the trauma networks assessed to absorb the spring 2020 pandemic hit. This study suggests that the care for major trauma patients was not substantially impacted by the SARS-CoV-2, 2020 first phase in France |
Nia et al., 2021 [40] | Wien Klin Wochenschr | Retrospective | Austria | Although trauma of all age groups and severities will continue to occur, the tendency during a lockdown will be a greatly reduced case load. Nevertheless, with no significant drop in major injuries, resources need to remain readily available for any future waves The importance of versatility in managing limited resources has been highlighted, always adapting to an ever-changing situation. This will ensure the highest levels of service are maintained, reducing complications and ultimately improving patient outcomes |