Anticipating a new pandemic; what to expect for musculoskeletal extremity injuries at the Emergency Department

Background: The rapid, extensive spread of COVID-19 had a profound impact on our healthcare system. The imposed restrictions by the governments impacted the incidence of musculoskeletal injuries. Comparative data on number of patients, types of injuries, underlying trauma mechanisms, and proportion of operative treatment in musculoskeletal extremity injuries can be of value to healthcare facilities when preparing for potential future pandemics, providing valuable insights into various crucial aspects of healthcare management, encompassing ED-management, operation room planning, surgical and orthopedic floor management, and out-patient clinic management. Methods: Count data for this retrospective study was gathered in a large urban teaching hospital and level 2 trauma center in the Netherlands during calendar weeks 11–18 in the pre-pandemic years 2018/2019 and pandemic year 2020 for adults and children. Types of injury were classified into eight distinct anatomic regions: shoulder/upper arm, elbow, lower arm/wrist, hand/finger, knee, lower leg, ankle, and foot. Results: In the years 2018, 2019, and 2020, a total of 1651, 1877, and 950 patients presented to the ED with musculoskeletal extremity injuries. In comparison to the pre-pandemic years 2018 and 2019 there was a decline of 701 patients (43 % reduction) and 927 patients (49 % reduction). The reduction was greater among children than adults. The decline in sports-related injuries is partially offset by injuries caused by other trauma mechanisms. A significant difference (P = 0.005) was observed for operative treatment in the region of “hand/finger” (7 % vs 13 %). Discussion: The pandemic resulted in a significant decrease of patients visiting the ED with musculoskeletal extremity injuries. The overall surgical operation rate remains comparable to pre-pandemic years, leading to a considerable reduction in the absolute number of patients requiring surgical treatment. This information can be valuable for hospitals in reallocating healthcare staff to provide essential care for patients in a future pandemic with governmental restrictions.