Epidemiology Of Orthopaedic Fractures During The COVID-19 Pandemic In the Military Setting: A Cross Sectional Study

Background: Pre-pandemic data (2017-2020) reveal that the Department of Orthopaedics in a military tertiary hospital has handled over 700 cases of traumatic injuries per year with motor vehicular accidents (MVA) as the leading cause, especially among male enlisted personnel. Due to COVID-19, movement of population has greatly changed, affecting the overall healthcare system. Pre-pandemic studies claim that male, aged 25 to 60 years, are most commonly injured with hand or wrist involvement due to MVA. During the pandemic, a number of literatures worldwide noted decrease incidence of fracture related to MVA and outdoor activities, with majority of cases attributable to domestic and home accidents. Limited studies are available involving injuries sustained during the pandemic in the Philippines. 

Objective: The aim of the study is to determine the demographics of trauma patients, and evaluate the fracture types, sites, laterality, incidence, and mechanism of injury among patients seen in this military tertiary hospital during the pandemic as opposed to the pre-pandemic period, and to know if the pandemic will affect the mechanism of injury in the military setting. 

Methodology: A cross-sectional study was used to compare the data pre-pandemic (March 2017 to February 2020) to the data of the first year of pandemic (March 2020 to February 2021). Data were extracted from the Summary of Duty of the Orthopaedics Department composed of age, sex, rank, laterality, diagnosis, and mechanism of injury. 

Results: A total of 1,774 patients were reviewed. Contrary to existing literatures, this study exhibited forearm and leg as the leading sites of injuries during pre-pandemic and pandemic period, respectively. Males, 21 to 30 years of age, and enlisted personnel were most commonly affected, often as a consequence of MVA throughout the study period. 

Conclusion: Significant reduction (~56%) of cases was observed at this institution due to the lockdown and strict protocols. Despite the decrease in mobility and outdoor activities in the country, MVA was noted to be the predominant mechanism of injury due to the incessant operation of uniformed men as front liners during the pandemic. Prevalent factors during the first year of pandemic were males, aged 21 to 30, with closed fracture occurring in the leg, with left laterality, dominated by enlisted personnel. Having anticipated which cases would be encountered during pandemic may aid for better preparation and management on the part of the surgeons.