RESUMO
While most literature on vitamin D supplementation in fracture patients focuses on fracture prevention, the effect of vitamin D on bone healing is a much less studied concept. The primary aim of this systematic review was to assess whether vitamin D supplementation in fracture patients improves clinical or radiological union complications. The secondary aims were to assess supplementation effect on patient functional outcome scores and bone mineral density (BMD). A systematic search of all relevant articles was performed using the following databases: MEDLINE, Embase, Google Scholar, and Web of Science. The population selection included human patients with a fresh fracture treated conservatively or operatively. The intervention included any form of vitamin D supplementation, compared to no supplementation or a placebo. The primary outcomes assessed were clinical or radiological union rates or complications arising from the nonunion. The secondary outcomes assessed were functional outcome scores, BMD scores after treatment, and pain scores. A total of fourteen studies, assessing a total of 2734 patients, were included. Eight studies assessed the effect of vitamin D on clinical or radiological union. Five studies reported no significant difference in complication rates when supplementing fracture patients. Alternatively, three studies reported a positive effect with supplementation between the groups. One of these studies found a difference only for early orthopaedic complications (<30 days), but no differences in late complications. The other two studies found significant differences in clinical union; however, no changes were observed in radiological union. Six studies investigated functional outcome scores after supplementation. Four of these studies found no significant differences between most functional outcome scores. Only three studies reported BMD outcomes, one of which found limited effect on total hip BMD. The overall findings are that vitamin D alone does little to influence fracture healing and subsequent union rates or functional outcome. The studies suggestive of a positive effect were generally of a lower quality. Further high quality RCTs are needed to justify routine supplementation at the time of fracture.
RESUMO
The effect of banning of nonessential services during the novel coronavirus disease 2019 (COVID-19) pandemic led to a perceived change in the volume of trauma cases and injury patterns. Literature indicates trends toward less trauma overall, with a decrease in outdoor, sporting, and motor vehicle injuries. However, studies focusing on outpatient orthopaedic trauma are less common. The main aim of this study was to assess the effect of COVID-19 pandemic on differences in inpatient and outpatient injury patterns and mechanisms. Patients requiring orthopaedic inpatient admission to Mater Dei Hospital, Malta, were analyzed between March 15 and June 17 between 2019 and 2021. For outpatients, all newly referred patients seen at the fresh trauma clinic (FTC) on the first 5 clinic days of each month from April to June between 2019 and 2021 were assessed. There were a total of 503, 362, and 603 hospital admissions during the data collection period from 2019, 2020 and 2021, respectively. There was a decrease in elbow ( p = 0.015) and pelvis ( p = 0.038) pathology since COVID-19 pandemic. In contrast, there was an increase in shoulder injuries ( p = 0.036) and lacerated wounds ( p = 0.012) in 2021. The most frequent mechanisms of injury for inpatients were low impact falls, and fall from heights greater than 1 m. Machine-related injuries ( p = 0.002), blunt trauma ( p = 0.004), and twisting injuries ( p = 0.029) increased in 2021. In the outpatient setting, there were a total of 367, 232, and 299 new referrals in 2019, 2020, and 2021, respectively. Injury patterns in this cohort were similar throughout, except for a significant increase in shoulder injuries during 2020 ( p = 0.009). There appears to be some minor variation in injury mechanisms due to lifestyle changes; however, most injury patterns have remained fairly constant. Further research should focus on the use of public awareness campaigns to decrease home-related trauma during enforced periods of lockdown.