Descriptive analysis of pediatric orthopedic surgical emergencies during the COVID-19 lockdown: single-center observational study in a pandemic red-zone area in France.

Abstract

INTRODUCTION\nLockdown involved strict confinement of children at home, radically affecting their way of life, with increased risk of domestic accidents and the temptation to step outside of the legal framework. The aim of the present study was to analyze the impact of lockdown on pediatric emergency turnover in a university reference center situated in a high-risk red zone and to describe specific management measures.\n\n\nHYPOTHESIS\nPediatric emergency turnover and the corresponding lesion mechanisms were altered by lockdown.\n\n\nMATERIALS AND METHODS\nAll children undergoing emergency orthopedic surgery during lockdown (group 1) were prospectively included, then retrospectively compared to series operated on during the same period in the previous 3 years. Demographic and surgical data were analyzed, and the pathway changes that were developed were detailed.\n\n\nRESULTS\nTurnover fell by a mean 33.5%, without change in indications. The most frequent lesions were wounds (54.3%), followed by fractures (34.3%) and infections (11.4%); the upper limbs were involved in 84.6% of cases. Lockdown had been infringed in 9.7% of traumas, mainly concerning fractures (55%). Postoperative management was modulated during lockdown in 34% of cases, without complications at the time of writing.\n\n\nDISCUSSION\nPediatric emergency turnover decreased, without major change in lesion mechanisms. Accidents associated with lockdown infringement were rare (<10%), demonstrating good adaptation on the part of these children living in an urban area. The adapted care pathway was beneficial, and will no doubt continue to optimize management in future, with accelerated circuits and use of telemedicine.\n\n\nLEVEL OF EVIDENCE\nIV, comparative retro-prospective study.