Effects of the COVID-19 Pandemic on Humeral Shaft Fracture Management and Its Outcomes

Abstract

Background and objective The coronavirus disease 2019 (COVID-19) pandemic necessitated a sudden and drastic shift in patient management throughout the healthcare system, to curb the spread of the disease and deal with resource limitations. Many surgical cases were canceled or delayed with only the most urgent and emergent cases taken up for treatment. It is unknown if and how these alterations affected patient outcomes. The purpose of this study was to compare time to fracture care and outcomes between patients treated for humeral shaft fractures prior to the COVID-19 pandemic and those treated during the pandemic. We hypothesized that the pandemic cohort would have a prolonged time to fracture care and worse outcomes than the pre-pandemic cohort. Materials and methods This was a retrospective cohort study performed within a single healthcare system. All humeral shaft fractures treated from March to June 2019 (pre-pandemic cohort) and March to June 2020 (pandemic cohort) were identified using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes and ICD-10-CM codes as well as Current Procedural Terminology (CPT) codes. Data on demographics, fracture characteristics, treatment, and outcomes were collected via chart and radiograph review. Outcomes analyzed included time to being made weight-bearing as tolerated (WBAT), radiographic union, and final follow-up; range of motion (ROM) at radiographic union and final follow-up; and rate of complications. Results The pre-pandemic cohort (n=19) was significantly younger with a mean age of 29 years than the pandemic cohort (n=17) with a mean age of 49 years (p=0.010). There were no other significant differences in demographics, fracture characteristics, or treatment type between the groups. Time to fracture care was not significantly different in the pre-pandemic cohort (five days) versus the pandemic cohort (four days). Time to being made WBAT, radiographic union, and final follow-up were not significantly different between the pre-pandemic (86, 113, and 98 days) and the pandemic cohorts (77, 106, and 89.5 days). ROM measurements in abduction at radiographic union were significantly different between the cohorts: in the pre-pandemic cohort, 100% of patients reached greater than 160 degrees; in the pandemic cohort, only 16.7% of patients reached greater than 160 degrees (p=0.048). There was a non-significant decrease in the proportion of patients who achieved the maximal category of ROM measurements in forward elevation and extension at radiographic union and abduction, forward elevation, and extension at final follow-up, as well as a non-significant increase in visual analog scale (VAS) pain scores at final follow-up between cohorts. There were no significant differences in the rate of complications. Conclusions Despite limited resources, reduced operating room availability, and increased utilization of virtual visits due to the COVID-19 pandemic, patients with humeral shaft fractures may not have faced delays in fracture care or worse outcomes compared to the pre-pandemic period. The pandemic cohort may have experienced significantly decreased ROM compared to the pre-pandemic cohort, which may reflect the decreased availability of physical therapy services and overall decreased activity levels due to the quarantine orders. However, we could not identify any other significant differences in the type of treatment, pain, complications, or time to union.

Keywords: covid-19; fracture; humeral shaft fracture; humerus; pandemic.