State-Wide COVID-19 Lockdowns Did Not Adversely Affect the Management of Acute Ankle Fractures
Authors: Smith Richard M. , Dixon Tonya L. , Shah Nihar 
Published: January 2022

Category: Ankle; Trauma; Other Introduction/Purpose: The novel coronavirus (COVID-19) pandemic has presented a unique challenge to orthopaedic trauma and operative fracture management throughout the United States. Various public health and safety measures imposed during the lockdown lead to cancelation or rescheduling of non-emergent or non-urgent surgery cases. In order to provide appropriate standard of care, certain operative cases were deemed urgent and managed on an inpatient basis. This change in practice had an impact on the management of acute ankle fractures which has previously reported excellent results and cost-savings with outpatient operative management. The goal of this study is to determine the impact of the COVID-19 lockdown and barriers to care in treating isolated operative ankle fractures in the inpatient setting. Methods: The current IRB approved study is a retrospective review of adult patients presenting to University of Cincinnati (UC) with isolated, operative ankle fractures. The study period consisted of patients who presented during the months of January 1st - July 1st 2020 to coincide with pre-, intra and post- COVID lockdown in Southwestern Ohio. Of note, the official mandated lockdown within the state of Ohio was March 23rd - May 1st with phased business re-openings after May 1st. Similarly, hospital operations including operative capacity was restricted until a return to full capacity on June 29, 2020. A total of 464 patient records were reviewed (159, 176, 129 ankle fractures for the respective years 2018-2020). A review of the data from years 2018, 2019 were analyzed for statistical comparison. Polytraumatized patients, open fractures and those with bilateral injuries were excluded. Results: The final cohort included 190 ankles (52, 71, 67, for 2018, 2019, 2020 respectively). This comprised of 71 males (38%), 119 females (62%). The average age of patients were 48+-19, 51+-18, 48+-20, respectively. There were no significant differences in BMI, smoking and diabetic status. There was a total of eight isolated ankle fractures during the immediate lockdown period of 2020, all managed with inpatient surgery. This was compared to the previous year 2019 (7/16 treated with inpatient management), versus 2018 (4/5 inpatient). Overall, among allcomers, 2020 had the lowest amount of acute fractures treated as outpatient, elective cases (34%) versus 45% -2019, 58%- 2018; however, this was not statistically significant. The length of stay for inpatients, time until surgical management, time to physical therapy clearance, postoperative follow up with index surgeon or midlevel providers were not significantly different among the 2020 cohort during and immediately after the state-wide lockdown. Conclusion: Little has been published about the effect of the coronavirus lockdown on acute fracture management. In this study of acute ankle fractures, strategic practice changes to predominantly inpatient management did not adversely affect patient care. However, there are disadvantages to inpatient versus outpatient management such as: (1) resource allocation (such as hospital beds during a pandemic) and (2) associated costs to both patients and hospital. Future efforts will be made to elucidate the cost analysis within our hospital system (not available at the time of this submission).