The coronavirus disease clavicle study: a predictor of future trauma trends

Background Clavicle fractures are a common presentation to the Emergency Department following falls and sporting injuries. During 2020, the COVID-19 pandemic brought with it a long period of social isolation resulting in a change of behavior patterns and in return, the presentation of fractures to our local hospitals. The effects of this global pandemic on the presentation and management of clavicles were noted with particular interest to the change in mechanism and its future implications. Methods We performed a longitudinal observational study in 10 hospitals in the North West of England, reviewing all patients presenting with a clavicle fracture during six weeks in the first peak of COVID-19 pandemic and compared these with the same time period in 2019. Collection points included the patient demographics, fracture characteristics, mechanism of injury and management. Results A total of 427 clavicle fractures were assessed with lower numbers of patients presenting with a clavicle fracture during the COVID-2020 period (n=177) compared with 2019 (n=250). Cycling related clavicle fractures increased three fold during the pandemic compared to the 2019 control group. We also noted an overall increase in clavicle fractures resulting from higher energy trauma as opposed to low energy or fragility fracture. We also found a faster time to surgery in the COVID cohort by 2.7 days on average when compared to 2019. Conclusions Government restrictions and the encouragement of social distancing led to behavioral changes with a vast increase in cyclists on the road. This created a significant rise in clavicle fractures related to this activity. This is likely to be further driven by the Government pledge to double cyclists on the road by 2025 in the United Kingdom.5 We forecast that this increase in cyclists, a behavior change accelerated by the pandemic, is a reliable predictor for future trauma trends.