Understanding the Impact COVID-19 Has Had on Traumatic Ankle Fractures in a UK Orthopaedic Department: Should Current Guidelines Be Revised?

Introduction Ankle fractures are common yet debilitating injuries. Surgery is the mainstay treatment for ankle fractures displaying a high suspicion of instability. During the coronavirus disease 2019 (COVID-19) pandemic, conservative management became prominent in patients with ankle fractures. This study assesses the variation in ankle fracture management during the COVID-19 versus pre-COVID-19 pandemic and also highlights how the lockdown affected patient's behaviour. Methods Data for patients with acute ankle fractures during the COVID-19 pandemic (March-June 2020) were retrieved using an electronic trauma database (eTrauma, Open Medical, London, UK). Patients were categorised as operative versus non-operative. The same data were extrapolated from eTrauma for pre-COVID times (March-June 2019). Data were cross-checked with inpatient notes. Patient demographics, mechanism of injury, patient outcomes (Foot and Ankle Outcome Score (FAOS)) and delay in presentation were also analysed. Result There was an increased number of acute ankle fractures referred to the orthopaedic department during the COVID-19 pandemic (n=161, 78.9% increase). However, 52% more cases were managed conservatively when compared with pre-COVID times. We also identified an increased presentation time from the date of injury to the orthopaedic review, along with a non-statistically significant decreased delay to surgery during the COVID-19 pandemic (p=0.131). Compared to 2019, FAOS scores were greater during the COVID-19 pandemic (p=0.049), despite no difference in the American Society of Anesthesiologists (ASA) grade between the two time periods. Conclusion Compared to the pre-COVID-19 pandemic period, more ankle fractures were managed conservatively in 2020, despite no significant difference found in baseline morbidity. In addition, patient outcomes were greater in 2020. Based on the data analysed, it would be prudent to review current ankle fracture management guidelines and consider a lower threshold for conservative management.