380 To Change or Not to Change? Has COVID-19 Altered Our Adherence to BOAST Guidelines on Management of Ankle Fractures?

Abstract

AimThe COVID-19 pandemic impacted the orthopaedic surgical ethos drastically. There was a lower threshold to manage fractures conservatively, in an attempt to curtail COVID-19 transmission rates amongst inpatients. This retrospective study evaluated our Orthopaedic department’s adherence to BOAST guidelines on ankle fractures, during COVID-19 and pre-COVID-19.MethodData on patient’s who presented with ankle fractures during the initial national lockdown in 2020 were compared against similar ankle fracture patterns one-year prior (pre-COVID) over a similar time frame. Patient clerking notes, operative notes, radiographical images and clinic letters were retrieved and compared against BOAST guidelines on ankle fractures. Management plans and time to surgery was extrapolated from these resources.ResultAnkle fracture incidence rates increased by 79.8% during the COVID pandemic when compared with data from 2019. 28% of ankle fractures in 2020 were managed operatively when compared with 80% in 2019. Average time to surgery during the pandemic improved by 1.64. Adequate documentation for neurovascular status, as per BOAST guidelines, was 30.5% in 2019 and 27% in 2020. Pre- and post-reduction views were available in 87% of cases in 2019 and 83% in 2020.ConclusionsAs a third national lockdown is upon us, evaluation of BOAST guidelines on ankle fractures would be worth revising. Teaching and posters were distributed throughout the department as a strategy to improve adherence to BOAST guidelines on ankle fractures. Furthermore, regular follow up clinics at specific times and post-management follow up clinics would be worth analysing to identify changes in patient satisfaction and clinical outcome.