Increase in paediatric bone stress injuries: a single-center study during the COVID-19 pandemic.

Abstract

Background: Melbourne, Australia was considered the most locked-down city during the COVID19 Pandemic. School was conducted from home and all organized sport ceased. Our institution noted an increased presentation of bone stress injuries (BSI) ranging from periostitis to stress fractures. This study reviews the prevalence of these injuries to gain insights into BSI presentation, diagnosis and best management.

Methods: A retrospective review of lower limb long bone stress injuries between April 1st 2020 and March 31st 2022, and from 2018 to 2020 for comparison, was conducted. A chart review of those meeting inclusion criteria for demographics, fracture characteristics, investigations, and treatment administered was conducted.

Results: Thirteen patients (two female, 11 male) met inclusion criteria. Only four patients were identified in the comparison period. The average age was 11.6 years, and average symptom duration was 7 weeks. Distinct morphologies were noted, specifically three discrete patterns of tibial injury were identified. Patients underwent an average of three imaging studies prior to diagnosis. Nine of 13 patients were prescribed a period of non-weight bearing, averaging 3.5 weeks. Seven of 13 patients were prescribed a formal 'partial weight bearing' (50%) period averaging 6.4 weeks.

Conclusion: There was a significant increase in paediatric BSI presentation over the COVID-19 lockdowns. This may be linked to the effect of reduced physical activity. Knowledge of the three clear tibial morphologies identified in this study will inform future diagnosis and reduce investigation expenditure. These findings may inform public health measures during mandated lockdowns and raise a diagnostic framework for such injuries.