How does trauma secondary to unexpected extreme weather affect orthopaedic surgery departments? An epidemiological study on the Filomena snowstorm.

INTRODUCTION: Trauma secondary to extreme weather events may heavily impact the normal activity of orthopaedic surgery departments, especially in places not prepared to deal with them. The Filomena snowstorm, which happened in January 2021, has been one of the greatest snowstorms ever in Spain. During it, the constant influx of trauma patients made the Orthopaedic Emergencies Department (OED) to collapse. The primary objective of this study was to describe the orthopaedic injuries and changes in fracture's epidemiology observed during this exceptional period. Secondary objectives were to analyse the collected variables in order to minimize the future impact of these unexpected extreme weather events.

MATERIALS AND METHODS: Retrospective cohort study between patients that came to the OED during the snowstorm (Filomena group) and those who came on the same period of the previous year (Control group). The following data were collected: age, sex, injury location, injury mechanism, diagnosis, AO/OTA fracture classification, treatment type (conservative vs surgical) and delay to surgical treatment.

RESULTS: A total of 1237 patients were included in total, 655 patients from the Filomena group and 582 from the Control group. One in two patients in the Filomena group sustained a fracture (50.7% vs 23.2%). The most frequent diagnosis on the Filomena group was distal radius fracture (16.2%), five times more frequent than in the Control group (3.4%). A significant increment was also observed in the incidence of ankle (21.7%) and proximal humerus (33%) fractures. In Filomena, surgically treated fractures increased by 168%, being more severe, as C-type fractures were more prevalent (23% vs 13%). Mean delay to surgery was 6.78 days during the snowstorm.

CONCLUSION: Unexpected snowstorms entail an exponential rise in orthopaedic care demand and OED pressures. A significant increment in orthopaedic trauma surgery, up to 168% more, particularly distal radius, proximal humerus and ankle fractures it is to be expected, which will imply elective surgery cancellation, damaging patients and increasing costs.