The impact of confinement on orthopaedic and trauma surgical activity

Introduction: On the 16th of March 2020, in the face of a health emergency declared in France, the govern-ment imposed containment measures whose impact on orthopaedic and trauma surgery remains to be demonstrated. The hypothesis of this study was that confinement reduced orthopaedic and trauma surgi-cal activity. The main objective was to assess orthopaedic and trauma surgical activity during confinement and to compare it to the activity outside confinement.Materials and methods: This was a retrospective, monocentric, observational and comparative study of a continuous cohort of patients included during the confinement period of March 16th to May 11th, 2020. This cohort was retrospectively compared to a group of patients over the same non-confinement period in the previous year, from March 16th to May 11th, 2019. The primary outcome measured was the incidence rate of surgical activity in 2020 versus 2019 over an identical period. The secondary outcome was the analysis of the trauma identified.Results: The number of patients operated on was significantly reduced during confinement: 194 patients were included in 2020, i.e. an incidence of 57 per 100,000 inhabitants against 772 patients included in 2019, i.e. an incidence of 227 per 100,000 inhabitants; p < 0.001. Planned orthopaedic surgery decreased from an incidence rate of 147 in 2019 to 5 in 2020 per 100,000 inhabitants (p < 0.001). Trauma surgery decreased from an incidence rate of 80 in 2019 to 50 in 2020 per 100,000 inhabitants (p: NS). We found a significant increase in patients over 65 years of age during confinement, 70% compared to 61% in 2019; p = 0.04. The rate of femoral neck fractures was significantly increased during confinement, 48.5% com-pared to 39.3% in 2019; p = 0.03. Degenerative surgery was significantly reduced during confinement (p < 0.001). Discussion: This study shows that the surgical activity of orthopaedics and trauma was significantly reduced by confinement, with a difference in incidence of 170 per 100,000 inhabitants, thus confirming the hypothesis of the authors. This decrease is due to both the cessation of planned orthopaedics and the 40% decrease in the number of trauma patients. During confinement, the percentage of patients over the age of 65 with a fracture increased significantly.Conclusion: Confinement had a significant impact on orthopaedic and trauma surgical activity.Level of evidence: III; comparative and retrospective.(c) 2021 Published by Elsevier Masson SAS.