The coronavirus disease clavicle study: a predictor of future trauma trends

Ghazal Hodhody; Joann W Y Lum; Sadia Afzal; Sophie Rogers; Leanne Dupley; Saleem Mastan; Krishna Sagar Karanam; William Fletcher; Nicholas Ward; Neelam Patel; Fayez Almari; Kenneth Koo; Isabel Hughes; Thomas Collins; Christopher Jump; Matthew Bradley; Michael S Greenhalgh; Samuel Newman; Muhammad Yasir Tarar; Jack Gleave; Jack Buchanan; Emma V Mulgrew; North West Orthopaedic Research Collaborative

doi:10.1016/j.jseint.2021.12.012

The coronavirus disease clavicle study: a predictor of future trauma trends

JSES Int. 2022 May;6(3):362-367. doi: 10.1016/j.jseint.2021.12.012. Epub 2022 Feb 1.

Authors

Ghazal Hodhody¹, Joann W Y Lum¹, Sadia Afzal¹, Sophie Rogers², Leanne Dupley³, Saleem Mastan⁴, Krishna Sagar Karanam¹, William Fletcher⁵, Nicholas Ward¹, Neelam Patel⁶, Fayez Almari⁷, Kenneth Koo⁷, Isabel Hughes⁸, Thomas Collins⁶, Christopher Jump⁹, Matthew Bradley⁶, Michael S Greenhalgh³, Samuel Newman², Muhammad Yasir Tarar¹⁰, Jack Gleave⁶, Jack Buchanan⁵, Emma V Mulgrew¹; North West Orthopaedic Research Collaborative

Affiliations

¹ Royal Bolton Hospital, Bolton, UK.
² University Hospitals, Morecambe Bay, Lancaster, UK.
³ Royal Preston Hospital, Preston, UK.
⁴ Victoria Hospital, Blackpool, UK.
⁵ Royal Blackburn Hospital, Blackburn, UK.
⁶ Manchester Foundation Trust Hospitals, Manchester, UK.
⁷ Salford Royal Hospital NHS Trust, Salford, UK.
⁸ Stepping Hill Hospital NHS Trust, Stockport, UK.
⁹ Royal Oldham Hospital, Oldham, UK.
¹⁰ Blackpool Victoria Hospital, Blackpool, UK.

Abstract

Background: Clavicle fractures are a common presentation to the emergency department after falls and sporting injuries. During 2020, the coronavirus disease 2019 (COVID-19) pandemic brought with it a long period of social isolation, resulting in a change of behavior patterns and, in return, the presentation of fractures to our local hospitals. The effects of this global pandemic on the presentation and management of clavicles were noted with particular interest to the change in mechanism and its future implications.

Methods: We performed a longitudinal observational study in 10 hospitals in the North West of England, reviewing all patients presenting with a clavicle fracture during 6 weeks in the first peak of COVID-19 pandemic and compared these with the same period in 2019. Collection points included the patient demographics, fracture characteristics, mechanism of injury, and management.

Results: A total of 427 clavicle fractures were assessed with lower numbers of patients presenting with a clavicle fracture during the COVID-2020 period (n = 177) compared with 2019 (n = 250). Cycling-related clavicle fractures increased 3-fold during the pandemic compared with the 2019 control group. We also noted an overall increase in clavicle fractures resulting from higher energy trauma as opposed to low energy or fragility fracture. We also found a faster time to surgery in the COVID cohort by 2.7 days on average when compared with 2019.

Conclusions: Government restrictions and the encouragement of social distancing led to behavioral changes with a vast increase in cyclists on the road. This created a significant rise in clavicle fractures related to this activity. This is likely to be further driven by the government pledge to double cyclists on the road by 2025 in the United Kingdom. We forecast that this increase in cyclists, a behavior change accelerated by the pandemic, is a reliable predictor for future trauma trends.

Keywords: COVID-19; Clavicle; Cycling; Fracture; Pandemic; Treatment.