No Delay in Care of Ambulatory Orthopaedic Fractures Observed During the Early Coronavirus-2019 Pandemic

A Retrospective Cohort Study

David Martin, MD; Corey Bindner, MD; John Dawson, MD; Scott Mitchell, MD; Christopher Perkins, MD; Omar Atassi, MD


Curr Orthop Pract. 2022;33(6):514-518. 

In This Article

Abstract and Introduction


Background: The purpose of this study was to assess the impact of social distancing orders on ambulatory orthopaedic fracture care at a level 1 trauma center during the Coronavirus Disease 2019 (COVID-19) pandemic.

Methods: All ambulatory orthopaedic fractures that presented to the author's Level 1 trauma center were analyzed retrospectively between December 2019 and June 2020. Patients were divided into prepandemic (n = 377) and pandemic (n = 224) groups based on the date of presentation. Primary outcomes included new ambulatory fracture volume, and time to presentation and surgery. Secondary outcomes included fracture type and clinic no-show rates.

Results: In the first 8 wk after the pandemic began, there was a 60.8% decrease in new patients with ambulatory fractures (24.6/week pre-pandemic, 9.63/week during the first 8 wk, P = 0.001). The presentation rate of patients with new ambulatory fractures returned to the prepandemic baseline after the first 8 wk of the pandemic. No significant difference in time to presentation or surgery was noted between groups. There was no statistically significant difference in the presentation rate of the most commonly treated fracture types (ankle, distal radius, hand, or foot) between groups. There was a statistically significant increase in overall clinic no-show rate during the pandemic period.

Conclusions: An initial decrease in ambulatory fracture volume was seen during the first 8 wk of the COVID-19 pandemic. No delay in time to presentation or time to surgery was seen between groups. After the first 8 wk of the pandemic, a return to normal ambulatory fracture volume was seen.

Level of Evidence: Level III.


The World Health Organization (WHO) declared Coronavirus Disease 2019 (COVID-19) a pandemic as SARS-CoV-2 spread across the world. Following the announcement by WHO on March 11, 2020, many countries established stay-at-home orders and social distancing guidelines.[1] Social distancing practices varied in different regions and at different phases of the pandemic. In healthcare, in-person clinic visits were decreased, and elective surgeries were intermittently halted during times of limited hospital capacity. These changes represented the first social distancing policies in the modern era. Thus, it was prudent to outline the effects of social distancing in case such a practice is considered in the future.

Although studies have looked at the overall change in orthopaedic trauma volume during the pandemic,[2–4] much of orthopaedic fracture care presents on an ambulatory basis, and the effect of the COVID-19 pandemic on that has not been explored. Traumatic injuries such as motor vehicle collisions and geriatric falls that require emergency medical services (EMS) to present to the hospital will likely continue to present in a timely manner. Ambulatory orthopaedic fracture care may be affected disproportionately since patients may be hesitant to present for care due to perceived risks of the virus. The treatment of many orthopaedic fractures, both operatively and nonoperatively, requires timeliness to allow for appropriate reduction and maintenance of alignment to allow for healing. Delays in treatment can result in changes to management, malunion, and increased complications.[5–9]

The goals of this study were to characterize the volume of ambulatory orthopaedic fractures that presented to a clinic and the emergency room immediately after the initial implementation of social distancing practices. The authors hypothesized that there would be an overall increased delay in care for ambulatory orthopaedic fracture patients during the early COVID-19 pandemic.