Changes in Distal Radius Fracture Incidence Across COVID-19 Lockdown Phases: A Nationwide Population-Based Study of 62,731 Cases in Israel.

BACKGROUND

Distal radius fractures (DRFs) are common upper-extremity fractures in older adults and are often considered sentinel events for frailty and future falls. COVID-19 lockdowns introduced major mobility restrictions that altered physical activity patterns and injury epidemiology.

OBJECTIVE

To describe nationwide trends in DRF incidence before, during, and after COVID-19 lockdown phases in Israel, and to interpret these trends in the context of deconditioning and rehabilitation needs.

METHODS

This retrospective population-based cohort study analyzed electronic health records from Clalit Health Services, covering > 4.5 million insured individuals. Adults aged ≥ 18 years with a documented DRF between June 2019 and December 2022 were included in the phase-based analysis. Seven pandemic phases were defined according to national restriction policies. DRF incidence was calculated as cases per 100,000 insured individuals per day, and demographic trends were described across phases.

RESULTS

Overall, 62,731 DRFs were identified (mean age 57.1 ± 19.0 years; 58.4% female). DRF incidence declined by 27% during the first national lockdown compared with the pre-pandemic period. Incidence increased across later phases and exceeded baseline in the post-pandemic period (+19.8%). Mean age rose over time, and the proportion of fractures among women was higher in later phases.

DISCUSSION: DRF incidence showed a marked short-term decline during strict lockdowns followed by a sustained rebound above baseline. These patterns likely reflect combined effects of restrictions, behavioral adaptations, and lockdown-related deconditioning. DRFs may indicate functional vulnerability, supporting timely rehabilitation and integrated fall-prevention strategies, including tele-rehabilitation, during and after periods of restricted mobility.