Effect of COVID-19 lockdowns on maxillofacial fractures in New Zealand: a retrospective study

Introduction: The New Zealand Accidents Compensation Corporation received 28,901 new claims for maxillofacial fractures between January 2018 and December 2021, at an annual cost of NZ$70–80 million. We have previously reported interpersonal violence as the most common cause of maxillofacial fractures disproportionately affecting young Māori males. This study provides an update on the incidence and cause of maxillofacial fractures with a specific review of the impact of COVID-19 lockdowns. Methods: Patients referred to the Wellington Regional Plastic, Maxillofacial and Burns Unit from 1 January 2018 to 31 December 2021 were identified from our maxillofacial fracture database. Age, ethnicity, gender, cause of injury, risk factors, and fracture pattern and management were analysed. Results: Out of 1281 patients identified, 75.2 per cent were male, most commonly (38.7%) aged 16–30 years. Interpersonal violence, falls and sports accounted for 37.6 per cent, 24.9 per cent, and 24.0 per cent of all maxillofacial fractures, respectively. Māori (22.0%) and New Zealand Europeans (55.7%) were the two largest groups, most commonly affected by interpersonal violence and falls, respectively. There was a relative increase in referral rates for females and for those older than 60 years (1.78 per 10 person-days versus 0.014 per 10 person-days and 4.2 per 10 person-days versus 1.8 per 10 person-days, respectively) and a decrease in the rates of interpersonal violence and sports related referrals (1.2 per 10 person-days versus 3.4 per 10 person-days and 0.41 per 10 person-days versus 2.19 per 10 person-days, respectively) during COVID-19 lockdowns, compared with outside lockdown. Conclusions: Interpersonal violence remains the main cause of maxillofacial fractures. There is a need for a national prevention strategy to reduce this. During COVID-19 lockdowns, there was a relative increase in the referral rates of females aged 60 years and over. Both sports and interpersonal violence showed significantly reduced referral rates during lockdowns, while falls, road traffic accidents and other were referred at a similar rate as out of lockdown.