Impact of the COVID-19 Pandemic on Buckle Fracture Treatment.

Abstract

Background: Based on the existing consensus in the literature, we have coined a term at our institution to describe optimal treatment for distal radius buckle fractures: Buckle Evidence-based Strategic Treatment (BEST). BEST includes a single provider visit, education, a removable wrist brace/bandage, no additional follow-up visits, and no additional X-rays. During the COVID-19 pandemic, many providers were pressured to reduce the number of in-person visits, promote physical distancing, and minimize in-person interaction with the healthcare system. It is unknown if a secondary effect of the COVID-19 pandemic was increased use of BEST practices and if there was a sustained effect. This investigation analyzed the adherence to BEST practices for treating distal radius buckle fractures in the pre-COVID-19 and COVID-19 era.

Methods: A retrospective cohort study of buckle fracture care was conducted across 2018-2019 (pre-COVID-19) and 2020-2022 (COVID-19 era). Subset analysis was also conducted for 2020 (peak COVID-19 era) and 2021-2022 (post-peak COVID-19 era). Adherence to BEST practices was assessed by chart review. The provider type was documented and subclassified into fellowship-trained pediatric orthopaedic surgeons, non-pediatric fellowship-trained orthopaedic surgeons, and non-physicians. Analyses were performed using chi-squared testing.

Results: A total of 602 distal radius buckle fractures met inclusion, with an average patient age of 9.4 years. Pre-COVID-19 BEST practice adherence was 11.15%. During peak COVID-19 era, adherence rates improved significantly to 41.18% (P < .001). This effect was sustained for the post-peak COVID-19 era. There were significantly different rates of adherence depending on provider type (P < .001).

Conclusions: The COVID-19 pandemic was associated with a significant increase in BEST practice utilization for buckle fracture management across all provider types. Adherence to BEST practices varied significantly based on provider type, with pediatric fellowship-trained orthopaedic surgeons having the highest level of adherence. This study demonstrates that external factors can impact treatment decisions for distal radius buckle fractures. Advocacy to change practice patterns for pediatric fracture care must first understand the factors that influence decision-making.

Key concepts: (1)The COVID-19 pandemic was associated with an increase in the adoption of BEST practices for the management of buckle fractures across all provider groups.(2)Fellowship-trained pediatric orthopaedic surgeons have the highest level of BEST practice adherence compared to other provider types.(3)Initiatives aimed at altering clinical practice must prioritize an understanding of the decisional factors affecting healthcare providers.

Level of evidence: III.