PEDIATRIC SPORTS INJURY EPIDEMIOLOGY DURING COVID-19 PANDEMIC

Background: The COVID-19 pandemic has prompted a multitude of public health response measures including social distancing, school cancellations, and cessation of organized sports. A change in the epidemiology of injuries commonly caused by sporting activities is expected. Hypothesis/Purpose: Examine the effect of public health measures on the incidence and characteristics of common pediatric sports injuries. Methods: This is a retrospective cohort study comparing sporting injuries presenting to a level I pediatric trauma hospital during the COVID-19 pandemic to sporting injuries during a pre-pandemic period at the same institution. Nine specific injury types were evaluated including ACL injury, meniscus injury, patellar dislocation, osteochondritis dissecans (OCD), shoulder dislocation, ankle sprain, clavicle fracture, medial epicondyle fracture, and tibial spine fracture. Patients were included if they presented for initial care between 3/15/20 and 4/15/20 for the “pandemic” group and the same time window in 2018 and 2019 for the “pre-pandemic” group. Results: 487 patients were included in our study with an average of 222.5 patients in 2018 and 2019 compared to 42 patients in 2020. The average patient age decreased during the pandemic compared to the pre-pandemic period (9.4 ± 6.0 vs 12.4 ± 4.2, p=0.007). Additionally, a decrease in the proportion of injuries attributed to sports (26.2% vs 47.6%, p=0.005) and those occurring at school/daycare (4.8% vs 10.3%, p<0.001) were observed. During the pandemic there was an increase in the proportion of injuries occurring at the patients home (50.0% vs 16.9%, p<0.001)(Table 1). The distribution was significantly different across the nine injury types included with a decrease in the proportion of ankle sprains (31.0% vs 59.8%, p<0.001) and an increase in the proportion of clavicle fractures (50.0% vs 16.2%, p<0.001)(Figure 1). For ankle sprains, there was no significant difference in the proportion of anterior talofibular ligament injuries to high ankle sprains (p=0.898). There was no delay in presentation in the “pandemic” group compared to the “pre-pandemic” group (6.6 ± 9.6 vs 5.4 ±9.9, p=0.424). Conclusion: At our institution, we observed an over fivefold reduction in presentation for common pediatric musculoskeletal injuries typically associated with sports. The dramatic drop off in injuries occurring across both sports and non-sports injury mechanisms raises concern for presentation of untreated injuries in the future. Additionally, the increased proportion of injuries occurring in the home setting creates an opportunity for emphasis to be placed on basic safety precautions, especially for young children. Tables/Figures: [Table: see text][Figure: see text]

Download Full-text

Arthroscopic modified Broström operation versus open reconstruction with local periosteal flap in chronic ankle instability

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-021-03949-2 ◽

2021 ◽

Author(s):

Moritz Mederake ◽

Ulf Krister Hofmann ◽

Ingmar Ipach

Keyword(s):

Surgical Procedures ◽

Ankle Instability ◽

Chronic Ankle Instability ◽

Anterior Talofibular Ligament ◽

Ankle Sprains ◽

Periosteal Flap ◽

Significant Difference ◽

Open Reconstruction ◽

One Year

Abstract Introduction The modified Broström operation (MBO) has found widespread use in the therapy of lateral chronic ankle instability (CAI). However, alternative surgical techniques like the open reconstruction using a periosteal flap (RPF) are still an important part of the surgical treatment of lateral CAI. Both procedures differ in terms of the reconstruction material used and the surgical procedure. Comparative studies on the surgical therapy of CAI are limited and generally refer to similar surgical procedures. Aim of this study was to compare the arthroscopic MBO and the RPF. Materials and methods We retrospectively analysed 25 patients with lateral CAI after a tear of the anterior talofibular ligament (ATFL). 14 patients received arthroscopic MBO and 11 patients received RPF. We compared the postoperative outcome between both groups with respect to subjective instability, the number of ankle sprains, pain, complications and follow-up operations as well as the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score. Results Both surgical procedures resulted in a significant improvement in pain, in subjective instability, in the reduction in the frequency of ankle sprains and improvement in the AOFAS ankle-hindfoot score one year postoperatively. Three months postoperatively, the values for pain and instability of the MBO group were significantly better compared to the RPF. One year after the operation, these differences were evened out. Also in terms of complications and follow-up operations, no significant difference was found between the two procedures. Conclusions Both surgical procedures give very good results one year postoperatively in terms of pain, instability, function and complication rate. With significantly better results regarding pain and instability three months postoperatively, the MBO allows a faster recovery in patients operated with this technique.

Download Full-text

Singapore’s COVID-19 “circuit breaker” interventions: A description of individual-level adoptions of precautionary behaviours

Annals of the Academy of Medicine, Singapore ◽

10.47102/annals-acadmedsg.2020597 ◽

2021 ◽

Vol 50 (8) ◽

pp. 613-618

Author(s):

Aidan Lyanzhiang Tan ◽

Sheryl Hui-Xian Ng ◽

Michelle Jessica Pereira

Keyword(s):

Public Health ◽

General Population ◽

Circuit Breaker ◽

Foreign Worker ◽

Secondary Data ◽

Face Mask ◽

Incidence Rates ◽

Public Health Response ◽

Working From Home ◽

Significant Difference

ABSTRACT Introduction: Effectiveness of COVID-19 control interventions relies significantly on behavioural modifications of its population. Differing adoption rates impacts subsequent COVID-19 control. Hence, positive and sustained behavioural modification is essential for disease control. We describe the adoption rates of behavioural modifications for Singapore’s “circuit-breaker” (CB), the national public health response to the COVID-19 crisis, among the general population in the community. Methods: We conducted an interrupted-time series study using retrospective secondary data. We compared the proportion of Singaporeans who reported adopting specific behaviour modifications before, during and after CB. Behaviours of interest were working from home, performing hand hygiene, using face mask in public, and avoiding crowded areas. We compared change in incidence rates for community COVID-19 cases among the general population across the same time periods. Results: There was an increase in face mask usage (+46.9%, 95% confidence interval [CI] 34.9–58.8, P<0.01) and working from home (+20.4%, 95% CI 11.7–29.2, P<0.01) during CB than before CB in Singapore. Other self-reported behaviours showed no statistically significant difference. Change in daily incidence rates of community COVID-19 cases decreased from additional 0.73 daily case before CB to 0.55 fewer case per day during CB (P<0.01). There was no significant difference among all behaviour adoption rates after CB. Daily incidence of community cases continued to decrease by 0.11 case daily after CB. Conclusion: Community incidence of COVID-19 in Singapore decreased during CB and remained low after CB. Use of face masks and social-distancing compliance through working from home increased during CB. However, it is unlikely to influence other sources of COVID-19 such as imported cases or within foreign worker dormitories. Keywords: Behaviours, COVID-19, public health

Download Full-text

LATERAL ANKLE SPRAIN — AN UPDATE

Journal of Musculoskeletal Research ◽

10.1142/s0218957713300032 ◽

2013 ◽

Vol 16 (04) ◽

pp. 1330003

Author(s):

Shibli Nuhmani ◽

Moazzam Hussain Khan

Keyword(s):

Ankle Sprain ◽

Bone Fractures ◽

Sports Injury ◽

Ankle Injuries ◽

Anterior Talofibular Ligament ◽

Ankle Sprains ◽

Calcaneofibular Ligament ◽

Lateral Ankle ◽

Major Loss ◽

Sporting Activities

Ankle sprain injuries are the most common injury sustained during sporting activities. One-sixth of all sports injury loss time is from ankle sprains. Each year, an estimated 1 million people present to physicians with acute ankle injuries. Three-quarters of ankle injuries involve the lateral ligamentous complex, comprised of the anterior talofibular ligament (ATFL), the calcaneofibular ligament (CFL) and the posterior talofibular ligament (PTFL). Lateral ankle sprains typically occur when the rearfoot undergoes excessive supination on an externally rotated lower leg. The diagnosis of a sprain relies on the medical history including symptoms, as well as making a differential diagnosis mainly in distinguishing it from strains or bone fractures. Despite their prevalence in society, ankle sprains still remain a difficult diagnostic and therapeutic challenge in the athlete, as well as in society in general. The high incidence of ligamentous ankle injuries requires clearly defined acute care and a broad knowledge of new methods in rehabilitation. In addition to rapid pain relief, the main objective of treatment is to quickly restore the range of motion of the ankle without any major loss of proprioception, thereby restoring full activity as soon as possible. The purpose of this article is to review the anatomy, pathomechanics, investigation, diagnosis and management of lateral ankle sprains.

Download Full-text

Changes in Pediatric Sports Injury Presentation During the COVID-19 Pandemic: A Multicenter Analysis

Orthopaedic Journal of Sports Medicine ◽

10.1177/23259671211010826 ◽

2021 ◽

Vol 9 (4) ◽

pp. 232596712110108

Author(s):

Mitchell A. Johnson ◽

Kenny Halloran ◽

Connor Carpenter ◽

Nicolas Pascual-Leone ◽

Andrew Parambath ◽

...

Keyword(s):

Public Health ◽

Cohort Study ◽

Tertiary Care ◽

Pediatric Trauma ◽

The United States ◽

Musculoskeletal Injuries ◽

Significant Delay ◽

Public Health Response ◽

Level Of Evidence ◽

The Impact

Background: The current coronavirus 2019 (COVID-19) pandemic has prompted a multitude of public health response measures including social distancing, school cancellations, and cessation of organized sports. Purpose: To examine the impact of COVID-19 and corresponding public health measures on the characteristics of common pediatric musculoskeletal injuries associated with sports. Study Design: Cohort study; Level of evidence, 3. Methods: This was a multicenter retrospective cohort study comparing patients with sports injuries presenting to 3 geographically diverse level I pediatric trauma hospitals and outpatient orthopaedic surgery clinics in the United States during the COVID-19 pandemic and a prepandemic period at the same institutions. Patients were included if they presented for care between February 15 and July 15 in 2020 (pandemic cohort) or between March 15 and April 15 in 2018 and 2019 (prepandemic cohort). Results: Included were 1455 patients with an average age of 12.1 ± 4.5 years. When comparing patients presenting in 2018 and 2019 with those presenting in 2020, we observed a decrease in mean age during the pandemic (12.6 ± 4.0 vs 11.0 ± 5.2 years; P = .048). Additionally, a decrease in the proportion of injuries attributed to sports (48.8% vs 33.3%; P < .001) and those occurring at school (11.9% vs 4.0%; P = .001) was observed. The proportion of injuries attributable to clavicle fractures increased during the early stages of the pandemic (13.2% vs 34.7%; P < .001). There was no statistically significant delay to care in injuries presenting during the pandemic (41.5 ± 141.2 vs 19.23 ± 79.1 days; P = .175). Conclusion: Across 3 tertiary care institutions, patients were seen without significant delay during the pandemic. We observed a significant decline in pediatric musculoskeletal injuries associated with sports during the COVID-19 pandemic. This decrease has been accompanied by a shift in both injury type and mechanism.

Download Full-text