Non-union of a Tibial Plafond Fracture in a COVID-Positive Patient: A Case Report

Several studies have proposed a relationship between the coronavirus disease 2019 (COVID-19)-induced cytokine storm and prohibitive effects on the musculoskeletal system, including increased risk of fracture, osteoporosis, and impaired bone healing. To our knowledge, this is the first known case report involving a fracture non-union concomitant with COVID-19 infection and apparent cytokine storm.

A 47-year-old male presented with an open pilon fracture of the left ankle after falling off a 6-foot ladder. At his 4-month post-operative follow-up, the patient attempted to ambulate without his cam boot for the 1st time, causing acute displacement of his poorly healed tibia fracture. A non-union laboratory workup demonstrated elevated inflammatory markers indicative of septic non-union; however, the patient also tested positive for severe acute respiratory syndrome coronavirus 2 at this time. Because of this, antibiotic treatment was not initiated due to suspicion of a cytokine storm. One month later, the patient's inflammatory markers had decreased and he underwent revision surgery.

This case underscores the potential impact of COVID-19 on fracture healing and the importance of vigilant monitoring and differential diagnosis in managing non-union in COVID-19-positive patients.