Effect of COVID-19 on orthopedic injuries due to assault

Introduction: This study aims to determine changes in the rates of orthopedic injuries due to assault before, during, and after the COVID-19 pandemic. Methods: The National Electronic Injury Surveillance System (NEISS) hospital survey publicly available data was queried from 2000 to 2021, and summarized by fracture status, assault status, time-period relative to the COVID-19 pandemic (before: before 02/28/2020; during: 03/01/2020-02/28/2021; and after: 03/01/2021-onwards), and overall injury status. Pearson's chi-squared test and Fisher's exact test were used to assess categorical differences. A logistic regression model was applied to calculate odds ratios with 95 % confidence intervals. All analyses and data visualizations were conducted using R. Results: Females had increased fracture risk (39 % before, 47 % during, 46 % after; p < 0.001). Fracture increased in Hispanic (7.7 % before, 11 % during, 11 % after) and Black patients (14 % before, 17 % during, 19 % after; p < 0.001). Fractures increased most in those 55–64 years old (8.6 % vs. 11 %) and 65–74 years old (6.8 % vs. 10 %; p value < 0.001) before vs. during COVID. Mechanism of injury attributable to assault increased (5.8 % before, 6.9 % during, and 6.5 % after COVID; p < 0.001). Rates of assault perpetrated by a spouse/partner increased (6.8 % before, 8.4 % during, 7.0 % after COVID). Injuries attributable to assault were highest in 2020 at 6.91 %. Fractures attributable to assault were highest in 2021 at 15.28 %. Female and Black patients were at increased risk for fractures related to assault both during and after COVID. Assaults in school decreased during COVID (5.0 %–0.6 %). Assault related fracture increased most in patients aged 55–64 (4.8 % vs. 8.4 %) and decreased most in patients aged 10–14 (7.1 %–1.7 %). Conclusion: Our findings show that women, elderly, Hispanic, and Black patients were among the demographics most at risk for fractures during the COVID-19 period and represent a population that should be targeted for screening in the setting of orthopedic fracture clinic.