O2076: Changes in Incidence of Pediatric Fractures During the covid-19 Pandemic

Background: The cancellation of in-person scholastic and athletic events during the Coronavirus-19 (COVID-19) pandemic has affected rates and patterns of pediatric orthopedic trauma. The purpose of this study was to compare fracture incidence, mechanism of injury, and treatment patterns for pediatric patients presenting to a level 1 trauma center between the pre-pandemic (March to September 2019) and pandemic (March to September 2020) periods.

Methods: Patients were identified using our institutional database. The following inclusion criteria were utilized: age 18 years or younger at the time of presentation to the Emergency Department (ED), clinical and radiographic diagnosis of a fracture involving the upper/lower extremity or spine, and adequate imaging. A retrospective chart review was performed and the following information was obtained: age, gender, mechanism of injury, diagnosis (using Orthopaedic Trauma Association and Salter-Harris classifications), treatment, and follow-up. Basic descriptive statistics and comparative analyses were performed between the pre-pandemic and pandemic cohorts.

Results: 965 fractures were identified during the two time periods. Fracture incidence decreased 21.3% between the pandemic (n=425) and pre-pandemic (n=540) timeframes (p < 0.01). There was a decrease in the average monthly fracture rate pre-pandemic (77.1±16.0) versus during the pandemic (60.7±17.5) (p = 0.06). Comparing the pre-pandemic and pandemic cohorts: fractures resulting from bicycles increased from 3% to 6% (p = 0.03), motor vehicle/ATV collisions increased from 13.5% to 20.5% (p < 0.01), and ballistic injuries increased from 9.6% to 13.3% (p = 0.07). Sports-related fractures decreased from 18.1% to 6.8% (p < 0.01), and playground injuries decreased from 11.1% to 6.8% (p = 0.02).

Conclusion: These findings show a decrease in the total number of fractures between the pre-pandemic and pandemic cohorts, with a decrease in fractures from sports and playground injuries being the most significant. High energy motor vehicle/ATV collisions and ballistic injuries increased substantially, consistent with locally/nationally reported increases in gun violence and motor vehicle accidents during 2020. These data raise public health concerns regarding the effects of the pandemic as it relates to gun violence and driving habits. In addition, these findings may imply that sports and the use of playgrounds may be a path to violence reduction.