Short-term effects of COVID-19 on risk of traumatic fractures in China: a multi-city study

Abstract Introduction: Traumatic injury is a leading cause of death and disability worldwide, and fifth most common of in China. Along with the outbreak of COVID-19, strict control measures to restrict people’s movement have been conducted in China. Subsequently, the injury mechanisms and pattern of traumatic fractures changed significantly. This study aimed to investigate the associations between COVID-19 and fracture risk, and provide a targeted reference for the world through China’s experience.Methods: This was a retrospective study of a nationally representative sample of COVID-19 prevalence areas using stratified random sampling. The data of traumatic fracture sustaining patients, including age and sex, fractured sites, mechanism of injury, and concurrent fractures in selected hospitals, were collected from 10 January and 10 July, 2020. The epidemiologic characteristics of traumatic fractures and the associations between COVID-19 and fracture risk were explored using the descriptive epidemiological methods and distribution lag nonlinear model.Results: A total of 67,249 (52.3% males) patients (average age 49.4±19.4 years) with 68,989 fractures were included. The highest proportion of fractures were sustained to the tibia and fibula (14.9%), followed by the femur (13.6%), and ulna and radius (12.5%). Low-energy fractures accounted for 23.3%. With the increase of newly confirmed COVID-19 cases, fracture risk decreased for children, young and middle-aged adults, elderly men, high-energy fracture, and for residents in low and middle-prevalence areas.Conclusion: Fracture risk decreased sharply in all residents except elderly women, low-energy fractures, and in high-prevalence areas when newly confirmed COVID-19 cases increased in China. Primary (home) prevention measures are emphasized to prevent traumatic fractures during the COVID-19 pandemic.