Archives of Academic Emergency Medicine. 2020; 8(1): e63 LE T T E R TO ED I TO R Changes in Fracture Epidemiology Due to COVID-19 Cri- sis; a Letter to Editor Seyyed Saeed Khabiri1∗, Mohammad Hossein Nabian2, Heydar Zeynolabedin3, Javad Veisi3, Vahid Rastgou3, Mehdi Naderi4, Shokofeh Maleki4 1. Department of Orthopedic Surgery, Clinical Research Development Centre, Taleghani and Imam Ali Hospitals, Kermanshah University of Medical Sciences, Kermanshah, Iran. 2. Department of Orthopedic Surgery, Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran. 3. Department of Orthopedic Surgery, Faculty of Medicine, Kermanshah University of Medical Science, Kermanshah, Iran. 4. Clinical Research Development Centre, Taleghani and Imam Ali Hospitals, Kermanshah University of Medical Sciences, Kermanshah, Iran. Received: April 2020; Accepted: April 2020; Published online: 21 April 2020 Cite this article as: Khabiri S S, Nabian M H, Zeynolabedin H, Veisi J, Rastgou V, Naderi M, Maleki Sh. Changes in Fracture Epidemiology Due to COVID-19 Crisis; a Letter to Editor. Arch Acad Emerg Med. 2020; 8(1): e63. Dear Editor Since December 2019, when the first case of COVID-19 was reported in China, the main strategy of health policy mak- ers has been to quarantine and impose social restrictions, causing significant behavioral changes in people due to fear of infection (1, 2). Laws limiting traffic, reduced travel per- mits, paying attention to personal hygiene, and making ef- forts to clean up private and public environments are some of the changes that have been observed. We also noticed al- terations in patients’ admission to trauma centers. In a retro- spective cross-sectional study, demographic characteristics and type of fracture were analyzed in patients referring to the trauma center of Taleghani Hospital, Kermanshah, Iran, from 1s t March to 15t h April, in 3 consecutive years (2018 to 2020). 2,483 trauma patients with the mean age of 37.31 ± 22.86 years were studied (Table1). The findings showed that, the number of fractures has generally decreased in March and April 2020. The change is more prominent in children and young men aged 18 to 35 years, which may be due to reasons such as schools being closed, sports activities being ceased, and the decrease in traffic, as well as the reduction of acci- dents that have affected these age groups. The age, gender, and type of fracture had approximately the same pattern dur- ing the studied period in three years, but we have seen an in- crease in some specific fractures such as foot bone and ankle (figure1). The fractures of middle-aged women, such as those ∗Corresponding Author: Seyyed Saeed Khabiri; Department of Orthope- dic Surgery, Taleghani Hospital, Faculty of Medicine, Kermanshah Univer- sity of Medical science, Kermanshah, Iran. P.O box: 6715847167. E-mail: saeed.khabiri@gmail.com, Tel: +98-83-38367984 with osteoporosis, like proximal femur, humerus, and distal radius, seem to have decreased in number during this period. In the study of scott et al., during quarantine and social dis- tancing, despite the decrease in the total number of patients, fragility fracture statistics had remained the same (3). Also, in the study of chui et al., they noted that due to cancellation of elective surgeries and the reduction of hospital workload, patients with pelvic fractures will be able to receive preoper- ative care faster. And better care has been provided for these patients during the COVID-19 era (4). Indoor layout optimization and strengthening the muscles to prevent falling and care for high-risk people is important. A program to treat osteoporosis should also be actively imple- mented in people over the age of 65. It could be concluded that during the Corona era, because of the behavioral change of the people and the decrease in traffic, we have witnessed a decline in hospital referrals due to trauma and also a decrease in the incidence of fractures, especially those related to accidents. This report may help guide the efforts to improve the healthcare system for crisis preparedness and assist in allocating resources for treatment and predicting workloads. 1. Declarations 1.1. Acknowledgment The authors would like to thank Amir Akhashi, Nader Bahrami, Salam Ghamari, Omid Sohrabi, Bahareh Safari, and Clinical Research Development Centers of Taleghani and Imam Ali Hospitals, Kermanshah University of Medical Sci- ences, Kermanshah, Iran, for support, data gathering, coop- eration and assistance throughout the study period. This open-access article distributed under the terms of the Creative Commons Attribution NonCommercial 3.0 License (CC BY-NC 3.0). Downloaded from: http://journals.sbmu.ac.ir/aaem S S. Khabiri et al. 2 Figure 1: Types and number of fractures during the COVID-19 outbreak (March and April of 2020) and similar periods in 2018 and 2019. Table 1: Number of cases referred to the emergency department with fractures based on gender and age in the studied years Characteristic March 1s t to April 15t h 2018 2019 2020 Fracture Number 957 948 578 Gender Male 605 (63.2) 602 (63.5) 393 (67.9) Female 352 (36.8) 346 (36.5) 185 (32.1) Age Mean ± SD 35.41±22.65 37.97±23.15 39.37±22.51 SD: standard deviation. 1.2. Authors Contributions Conception and design of the study: Mohammad Hossein Nabian and Seyyed Saeed Khabiri Collection, assembly, possession of raw data: Heydar Zeyno- labedin, Javad Veisi, Vahid Rastgou and Seyyed Saeed Khabiri Statistical expertise :Mehdi Naderi and Shokofeh Maleki Analysis and interpretation of data: Seyyed Saeed Khabiri and Mehdi Naderi Authors ORCIDs Seyyed Saeed Khabiri: 0000-0002-8906-7660 1.3. Funding No benefits in any form have been received or will be re- ceived from a commercial party related directly or indirectly to the subject of this article. This open-access article distributed under the terms of the Creative Commons Attribution NonCommercial 3.0 License (CC BY-NC 3.0). Downloaded from: http://journals.sbmu.ac.ir/aaem 3 Archives of Academic Emergency Medicine. 2020; 8(1): e63 1.4. Conflict of Interest The authors declare that there is no conflict of interest. References 1. Parmet WE, Sinha MS. Covid-19–the law and lim- its of quarantine. New England Journal of Medicine. 2020;382(15):e28. 2. Wozniak A. Disparities and Mitigation Behavior during COVID-19. Federal Reserve Bank of Minneapolis; 2020. 3. Scott CE, Holland G, Powell-Bowns MF, Brennan CM, Gillespie M, Mackenzie SP, et al. Population mobility and adult orthopaedic trauma services during the COVID-19 pandemic: fragility fracture provision remains a priority. Bone & Joint Open. 2020;1(6):182-9. 4. Chui K, Thakrar A, Shankar S. Evaluating the efficacy of a two-site (COVID-19 and COVID-19-free) trauma and or- thopaedic service for the management of hip fractures during the COVID-19 pandemic in the UK. Bone & Joint Open. 2020;1(6):190-7. This open-access article distributed under the terms of the Creative Commons Attribution NonCommercial 3.0 License (CC BY-NC 3.0). Downloaded from: http://journals.sbmu.ac.ir/aaem Declarations References