Epidemiology and Clinical Outcomes of Foot and Ankle Trauma During the First Wave of the COVID-19 Pandemic in the New York Metropolitan Area.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel respiratory virus that has rapidly changed the practice of medicine. The authors sought to evaluate the clinical presentation and clinical outcomes of patients presenting with foot and ankle (F&A) trauma to the emergency department during the first wave of the pandemic. The authors retrospectively studied all patients who presented to an emergency department within their multicenter institution during the first wave of the pandemic in their region from March 1 to June 30, 2020, with F&A trauma. They compared this cohort with a matched control group of patients who presented the prior year. Demographics, perioperative factors, coronavirus disease 2019 (COVID-19) polymerase chain reaction testing/positivity rates, 30-day readmissions, and 30-day mortalities were collected and analyzed. During the pandemic, the authors saw a 62.0% decrease in the total number of patients presenting with F&A trauma. Patients who presented during the pandemic were significantly older and a greater proportion were male. There was a greater proportion of ankle fractures, fewer ankle sprains, and more open fractures presenting during the pandemic. A greater proportion of patients presenting to the emergency department were admitted (18.2% vs 12.5%). The 30-day readmission (n=13 [5.8%] vs n=38 [9.3%]) and mortality (n=4 [1.8%] vs n=3 [0.7%]) rates for admitted patients were similar (P=.114 and P=.232, respectively). The authors found that 9.6% of patients who presented had a positive COVID-19 polymerase chain reaction test result and that these patients had 20% mortality and readmission rates. [Orthopedics. 2021;44(5):313-319.].

Delay in Treatment of a Bimalleolar Ankle Fracture during Coronavirus Disease-19 COVID-19 Pandemic Leading to Amputation.

INTRODUCTION: Severe acute respiratory syndrome coronavirus-2 (SARs-CoV-2), also known as coronavirus disease-19 (COVID-19), is a novel respiratory disease which has fundamentally disrupted societal norms. Common responses to the pandemic have called for "social distancing" and national lockdowns. There is little evidence as to how public perception surrounding exposure to the virus may impact patient care. Here, we present a case of a patient who deferred medical treatment due to concerns regarding exposure to the virus. CASE REPORT: A 99-year-old female who presented to an emergency department of a community hospital on Long Island, New York, during the COVID-19 pandemic complaining of right ankle pain after a fall three 3 weeks ago. Fear of contracting COVID-19, led to initial avoidance of medical evaluation. On presentation, the patient presented with a Gustillo-Anderson Grade III A, bimalleolar ankle fracture with associated gangrene. After evaluation and a thorough discussion with the patient and her family, the patient underwent guillotine amputation. CONCLUSION: Public perception surrounding COVID-19 has created a sense of fear that can impact patient behaviors, such as prevent them from seeking medical care when necessary. As physicians, we need to make patients feel safe and increase availability to patient care during this time to prevent similar issues as demonstrated in this case.