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Candela V, Proietti R, Polizzotti G, Rionero M, Gumina S. Three Years of COVID-19 on Orthopaedic Trauma; Are We Going Back to Normality? MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1464. [PMID: 37629754 PMCID: PMC10456244 DOI: 10.3390/medicina59081464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/31/2023] [Accepted: 08/08/2023] [Indexed: 08/27/2023]
Abstract
Background and Objective: On March 2020, our country became a protected area due to the COVID-19 pandemic. The consequences of COVID-19 on trauma surgery were great. We aimed to evaluate the activity of the Trauma Centre of a highly populated suburban area over 30 days starting from the first day of restrictions, to compare it with the same period of 2019 and 2022 and to evaluate whether a progressive return to normality has taken place. Materials and Methods: All patients older than 18 years managed in our Trauma Unit between 8 March 2020 and 8 April 2020 (the first COVID-19 period) were compared to the same period of 2019 (a COVID-19 free period) and 2022 (the second COVID-19 period). Clinical records were examined. Five categories of diagnoses and six mechanisms of injury were distinguished. Results: There were 1351 patients [M:719-F:632; mean age (SD):49.9 (18.7)], 451 [M:228-F:223; mean age (SD):55.9 (18.4)] and 894 [M:423-F:471;mean age (SD):54.1 (16.7)] in the COVID-19 free and in the first and second COVID-19 periods, respectively (p < 0.05). In 2020, the most significant decrease was registered for sprains/subluxations (80%); contusions decrease by 77% while fractures decrease only by 37%. The lowest reduction was found for dislocations (26%). In 2022, dislocations decreased by only 16% and both fractures and sprains decreased by about 30% with respect to the pre-pandemic period. Patients with minor trauma (contusions) were half compared to 2019. Accidental falls remain the most frequent mechanism of injury. The incidence of proximal femur, proximal humerus and distal radius fractures remained almost unchanged during both pre-pandemic and pandemic periods. Conclusions: COVID-19 has markedly altered orthopaedic trauma. Injuries related to sports and high energy trauma/traffic accidents drastically reduced in 2020; however, we are slowly going back to normality: the same injuries increased in 2022 due to the progressive easing of restrictions. Elderly fractures related to accidental falls remained unchanged.
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Affiliation(s)
- Vittorio Candela
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Sapienza University of Rome, 00185 Rome, Italy; (R.P.); (G.P.); (M.R.); (S.G.)
| | - Riccardo Proietti
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Sapienza University of Rome, 00185 Rome, Italy; (R.P.); (G.P.); (M.R.); (S.G.)
- Istituto Chirurgico Ortopedico traumatologico (ICOT), 04100 Latina, Italy
| | - Giuseppe Polizzotti
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Sapienza University of Rome, 00185 Rome, Italy; (R.P.); (G.P.); (M.R.); (S.G.)
- Istituto Chirurgico Ortopedico traumatologico (ICOT), 04100 Latina, Italy
| | - Marco Rionero
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Sapienza University of Rome, 00185 Rome, Italy; (R.P.); (G.P.); (M.R.); (S.G.)
- Istituto Chirurgico Ortopedico traumatologico (ICOT), 04100 Latina, Italy
| | - Stefano Gumina
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Sapienza University of Rome, 00185 Rome, Italy; (R.P.); (G.P.); (M.R.); (S.G.)
- Istituto Chirurgico Ortopedico traumatologico (ICOT), 04100 Latina, Italy
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Park KH, Oh CW, Kim JW, Lee HJ, Kim HJ. Reliability of reverse sural artery fasciocutaneous flap in older adult patients: Comparison study between older and younger patients. Injury 2023; 54:110915. [PMID: 37421835 DOI: 10.1016/j.injury.2023.110915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 06/23/2023] [Accepted: 06/25/2023] [Indexed: 07/10/2023]
Abstract
BACKGROUND The reverse sural artery fasciocutaneous (RSAF) flap is a popular option for patients with soft tissue defects of the distal lower extremities. However, most studies have focused on young patients without comorbidities. This study aimed to report the clinical application of the RSAF flap and to evaluate its reliability in older adult patients. METHODS A retrospective study of fifty-one patients who underwent RSAF flap was included in this study between September 2016 and October 2021. Reconstruction outcomes and wound complications were compared between groups A (21 patients over 60 years of age) and B (30 patients under 60 years of age). RESULTS Overall, 74.5% of the flaps healed primarily. The demographics of the two groups were similar, except for comorbidities (P = 0.01). The risk factors that affected the survival of RSAF flaps were not significantly different between the two groups (P > 0.05). The rate of wound complications in group A (42.85%) was significantly higher than that in group B (13.3%) (P = 0.04). However, all wound complications were treated using a simple procedure (skin grafting or simple suturing). CONCLUSIONS The RSAF flap can be a reliable salvage option to repair soft tissue defects of the lower extremities in older adult patients. It is safe and easy to harvest and transfer the flap; however, surgeons should be aware of the possibility of wound complications in older patients with comorbidities.
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Affiliation(s)
- Kyeong-Hyeon Park
- Department of Orthopedic Surgery, Severance Children's Hospital, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Chang-Wug Oh
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu 41944, Korea.
| | - Joon-Woo Kim
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu 41944, Korea
| | - Hyun-Joo Lee
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu 41944, Korea
| | - Hee-Jun Kim
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu 41944, Korea
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Bolzinger M, Lopin G, Accadbled F, Sales de Gauzy J, Compagnon R. [Pediatric traumatology in "green zone" during Covid-19 lockdown: A single-center study]. REVUE DE CHIRURGIE ORTHOPEDIQUE ET TRAUMATOLOGIQUE 2023; 109:36-40. [PMID: 34188721 PMCID: PMC8229904 DOI: 10.1016/j.rcot.2021.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 09/28/2020] [Indexed: 02/02/2023]
Abstract
Introduction La période de confinement de 8 semaines, imposée en raison de l’épidémie liée au Covid-19, a entraîné une restriction de la circulation, un arrêt de la scolarité et des activités sportives. Notre hypothèse est que cette situation inédite a modifié temporairement l’épidémiologie des traumatismes chez l’enfant. Matériel et méthode Il s’agit d’une étude prospective réalisée pendant les 8 semaines de confinement. L’activité d’urgence traumatologique pédiatrique a été comparée à l’activité des 3 années précédentes à la même période. Résultats Pendant le confinement, le taux de passage aux urgences a diminué de 50 %. Le taux de patients opérés représentait 86 % par rapport aux 3 années précédentes. Les patients opérés pendant le confinement avaient une moyenne d’âge de 7,6 ans (âge médian 7,5) contre 9,3 ans (âge médian 9,4) les années précédentes. On notait une augmentation des accidents domestiques (59 % versus 23 %) et des accidents de trampoline (16 % versus 5 %), et une diminution des accidents de sport et des accidents de locomotion. Les plaies étaient plus fréquentes en période de confinement, représentant 35 % des actes chirurgicaux contre 13 % les années précédentes. Le nombre de patients opérés pour fracture au membre supérieur a diminué alors qu’il restait similaire pour le membre inférieur. Les fractures distales de l’avant-bras étaient moins fréquentes, ainsi que les fractures distales de jambe. Discussion Notre étude a montré pendant le confinement une réduction de 50 % de l’activité de traumatologie aux urgences sans diminution de l’activité au bloc opératoire. En cas de nouvelle période de confinement, nous recommanderions une réorganisation de l’accueil aux urgences permettant de libérer des équipes pour l’accueil des patients Covid-19; et le maintien d’un bloc opératoire pour les urgences chirurgicales. Une information pourrait être proposée au public pour la prévention des accidents domestiques, ainsi que des risques liés aux activités de trampoline. Niveau de preuve III.
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Affiliation(s)
- Manon Bolzinger
- Service d’Orthopédie, Hôpital des Enfants, 330, avenue de grande bretagne, 31300 Toulouse, France,Auteur correspondant
| | | | - Franck Accadbled
- Service d’Orthopédie, Hôpital des Enfants, 330, avenue de grande bretagne, 31300 Toulouse, France
| | - Jérôme Sales de Gauzy
- Service d’Orthopédie, Hôpital des Enfants, 330, avenue de grande bretagne, 31300 Toulouse, France
| | - Roxane Compagnon
- Service d’Orthopédie, Hôpital des Enfants, 330, avenue de grande bretagne, 31300 Toulouse, France
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Bolzinger M, Lopin G, Accadbled F, Sales de Gauzy J, Compagnon R. Pediatric traumatology in "green zone" during Covid-19 lockdown: A single-center study. Orthop Traumatol Surg Res 2023; 109:102946. [PMID: 33901717 PMCID: PMC8064820 DOI: 10.1016/j.otsr.2021.102946] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/20/2020] [Accepted: 07/27/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The 8-week lockdown for the Covid-19 epidemic in France restricted travel, and interrupted schooling and sports. The study hypothesis was that this exceptional situation temporarily altered childhood trauma epidemiology. MATERIAL AND METHOD A prospective study was performed during the 8 weeks of lockdown. Pediatric traumatology emergency activity was compared to that during the same period in the previous 3 years. RESULTS During lockdown, emergency consultations decreased by 50%. The number of patients operated on was 86% of that in the previous 3 years. Patients operated on during lockdown had a mean age of 7.6 years (median, 7.5 years) compared to 9.3 years (9.4 years). The rate of domestic accidents (59% versus 23%) and trampoline accidents (16% versus 5%) increased, while those of sport and locomotion-related accidents decreased. Wounds were more frequent, at 35% of procedures, versus 13% previously. The rate of surgery for upper-limb fracture deceased, while that of lower-limb fracture was unchanged. Distal forearm fracture was less frequent, as was distal tibial fracture. DISCUSSION The present study found a 50% decrease in pediatric traumatology emergency activity during lockdown, without decrease in surgery. In case of renewed lockdown, we recommend reorganizing emergency admission to free teams for management of Covid-19 patients, while maintaining operative rooms for emergency surgery. A general public information campaign could help prevent domestic accidents and risk related to use of trampolines. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Manon Bolzinger
- Service d’Orthopédie, Hôpital des Enfants, 330, Avenue de Grande Bretagne, 31300 Toulouse, France,Corresponding author
| | | | - Franck Accadbled
- Service d’Orthopédie, Hôpital des Enfants, 330, Avenue de Grande Bretagne, 31300 Toulouse, France
| | - Jérôme Sales de Gauzy
- Service d’Orthopédie, Hôpital des Enfants, 330, Avenue de Grande Bretagne, 31300 Toulouse, France
| | - Roxane Compagnon
- Service d’Orthopédie, Hôpital des Enfants, 330, Avenue de Grande Bretagne, 31300 Toulouse, France
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Evolving perceptions regarding receiving orthopaedic care during the Coronavirus 2019 (COVID-19) pandemic. CURRENT ORTHOPAEDIC PRACTICE 2022; 33:141-146. [PMID: 35222788 PMCID: PMC8862675 DOI: 10.1097/bco.0000000000001081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
As the Coronavirus 2019 (COVID-19) pandemic evolves, it is critical to understand how patients’ feelings and perceptions have changed. The aim of this study was to understand current feelings and concerns about seeking and receiving orthopaedic care 9 mo into the global pandemic.
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Gokhale S, D'sa P, Badurudeen AA, Carpenter EC. Epidemiology of Paediatric Orthopaedic Trauma, Before, During, and After the Outbreak of COVID-19 Pandemic: An Observational Study From a Tertiary Referral Center in Wales. Cureus 2021; 13:e19253. [PMID: 34900454 PMCID: PMC8648141 DOI: 10.7759/cureus.19253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction The outbreak of coronavirus disease 2019 (COVID-19) and the resultant lockdown has had a great impact on global healthcare. This observational study aimed to analyse the consequences of national lockdown on the epidemiology of significant paediatric orthopaedic trauma, presenting to a tertiary referral centre in Wales, during the COVID-19 pandemic in the United Kingdom. Methods Paediatric patients presenting with orthopaedic trauma, from March 2019 to July 2019 (baseline period), March 2020 to July 2020 (lockdown period), and March 2021 to July 2021 (post lockdown period), were identified and compared. Those aged less than 16 years, presenting with a significant orthopaedic injury, defined here for the study as, those requiring either manipulation under anaesthesia or, surgical intervention were included in this study. Results Mean age of children with significant orthopaedic injuries during the lockdown dropped significantly to 6.52 years in comparison to those during the baseline period (7.9 years), and post lockdown period (8.85 years). The incidence of outdoor injuries plummeted significantly from 64.71% in the baseline period, to 41.27% during the lockdown period, but rose to 80.65% in the post lockdown period. There was a 48% reduction in the number of children who required intervention in operating theatre during the lockdown period, in comparison to the other two study periods. Conclusion Our study reports a significant decrease in the incidence of paediatric orthopaedic trauma needing intervention in operating theatre during the lockdown period, with a significant rise in the incidence of domestic injuries, and relatively younger children sustaining these injuries. A public information campaign could help reduce the incidence of such domestic accidents during future lockdowns. We recommend improving awareness among parents, creating a safe indoor as well as outdoor environment to help reduce the incidence of fractures in the paediatric population. This will subsequently help in reducing the financial burden on an already stretched healthcare system.
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Affiliation(s)
- Sandeep Gokhale
- Trauma and Orthopaedics, University Hospital of Wales, Cardiff, GBR
| | - Prashanth D'sa
- Trauma and Orthopaedics, University Hospital of Wales, Cardiff, GBR
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Sabetkish N, Rahmani A. The overall impact of COVID-19 on healthcare during the pandemic: A multidisciplinary point of view. Health Sci Rep 2021; 4:e386. [PMID: 34622020 PMCID: PMC8485600 DOI: 10.1002/hsr2.386] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/21/2021] [Accepted: 08/22/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND AND AIMS The Coronavirus disease 2019 (COVID-19) pandemic globally changed the priorities of medical and surgical procedures. It has caused many healthcare systems to stop performing their routine screenings. Altering medical clinics to COVID-19 referral centers, lockdowns, and the public fear to refer to medical centers caused a significant reduction in the referral rate; especially in the elderly. This short review article highlights the transform in clinical practice during the post-COVID era and the need for future medical revolutions. METHODS A comprehensive literature search was separately performed by both authors. The articles published between 2019 and August 2021 were included in this study and selected according to a quality appraisal method. RESULTS We have summarized the possible corresponding changes in the diagnosis and treatment of all fields of medical care including internal medicine, surgical, and minor subcategories after the COVID-19 pandemic. We have also discussed the potential impacts of the pandemic on all these different categories and subcategories of medicine, including the outpatient setting and clinical work. We do believe that the lack of routine check-ups has led to an increase in the stage of disease in patients with a previously diagnosed problem. On the other hand, the dramatic change in the lifestyle of the population including restricted mobility and increased consumption of unhealthy food has caused metabolic syndrome and other new diseases that have not been diagnosed and properly managed. CONCLUSION Our findings revealed the urgent need for public health awareness. It indicated the need to carry out both psychological and screening approaches in the post-COVID era to not miss patients with a chronic disease and new cases who were undiagnosed during the COVID pandemic.
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Affiliation(s)
- Nastaran Sabetkish
- Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Hospital Medical CenterTehran University of Medical SciencesTehranIran
- ImmunologyAsthma and Allergy Research Institute, Tehran University of Medical SciencesTehranIran
| | - Alireza Rahmani
- Research Center for Prevention of Cardiovascular DiseaseInstitute of Endocrinology & Metabolism, Iran University of Medical SciencesTehranIran
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White PB, Partan M, Iturriaga C, Katsigiorgis M, Katsigiorgis G, Cohn RM, Bitterman A. Epidemiology and Clinical Outcomes of Foot and Ankle Trauma During the First Wave of the COVID-19 Pandemic in the New York Metropolitan Area. Orthopedics 2021; 44:313-319. [PMID: 34590956 DOI: 10.3928/01477447-20210819-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
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.].
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Kabariti R, Green N, Turner R. Drill splatter in orthopaedic procedures and its importance during the COVID-19 pandemic : an experimental study. Bone Jt Open 2021; 2:752-756. [PMID: 34493057 PMCID: PMC8479843 DOI: 10.1302/2633-1462.29.bjo-2021-0070.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIMS During the COVID-19 pandemic, drilling has been classified as an aerosol-generating procedure. However, there is limited evidence on the effects of bone drilling on splatter generation. Our aim was to quantify the effect of drilling on splatter generation within the orthopaedic operative setting. METHODS This study was performed using a Stryker System 7 dual rotating drill at full speed. Two fluid mediums (Videne (Solution 1) and Fluorescein (Solution 2)) were used to simulate drill splatter conditions. Drilling occurred at saw bone level (0 cm) and at different heights (20 cm, 50 cm, and 100 cm) above the target to simulate the surgeon 'working arm length', with and without using a drill guide. The furthest droplets were marked and the droplet displacement was measured in cm. A surgical microscope was used to detect microscopic droplets. RESULTS Bone drilling produced 5 cm and 7 cm droplet displacement using Solutions 1 and 2, respectively. Drilling at 100 cm above the target produced the greatest splatter generation with a 95 cm macroscopic droplet displacement using Solution 2. Microscopic droplet generation was noticed at further distances than what can be macroscopically seen using Solution 1 (98 cm). Using the drill guide, there was negligible drill splatter generation. CONCLUSION Our study has shown lower than anticipated drill splatter generation. The use of a drill guide acted as a protective measure and significantly reduced drill splatter. We therefore recommend using a drill guide at all times to reduce the risk of viral transmission in the operative setting. Cite this article: Bone Jt Open 2021;2(9):752-756.
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Affiliation(s)
- Rakan Kabariti
- Trauma & Orthopaedics, Princess Royal Hospital NHS Trust, Telford, UK
| | - Natalie Green
- Trauma & Orthopaedics, Princess Royal Hospital NHS Trust, Telford, UK
| | - Robert Turner
- Trauma & Orthopaedics, Princess Royal Hospital NHS Trust, Telford, UK
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Patients’ perceptions of receiving orthopaedic care during a pandemic: a patient survey. CURRENT ORTHOPAEDIC PRACTICE 2021. [DOI: 10.1097/bco.0000000000000988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bhat AK, Vijayan S, Acharya AM, Shetty S, Ampar N, Kanhangad MP, Hegde N. Operation theatre protocol for COVID-19 cases requiring orthopaedic surgery: A workflow without altering the existing infrastructure. J Clin Orthop Trauma 2021; 17:163-168. [PMID: 33776361 PMCID: PMC7979274 DOI: 10.1016/j.jcot.2021.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 02/19/2021] [Accepted: 03/15/2021] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION The surge in the number of trauma cases following relaxation of lockdowns in the backdrop of COVID-19 pandemic, has strained the existing infrastructure to cater to these patients and also prevent the spread of infection. Moreover, with the rise of newer strains, the period ahead has to be tread carefully to prevent resurgence of infections. There have been recommendations regarding the ideal setup to operate orthopaedic cases in this pandemic scenario. However, many of the hospitals in India with financial and logistic constraints are unable to implement these structural changes into their existing setup. We propose a model which can be used in an existing operation theatre which has a single entry and exit corridor, which is the layout in many hospitals. METHODOLOGY A protocol with the consultation of a panel of health care professionals was designed on the basis of WHO guidelines in a way so as to remain dynamic. Prior to its implementation, online classes were conducted and a dry run of the protocol was done with the whole team involved. The theatre layout is one with a single entry and exit and had predesignated rooms. The personnel were divided into 3 teams, each with a fixed set of people and preset workflow, to be followed during entry and exit. Five COVID positive cases have been operated since then using the protocol and has been used as a pilot study to further amend the protocol. CONCLUSION This model can be used as a guideline by hospitals having a limited infrastructure, to develop their own protocol to operate on COVID positive cases, in the present situation of increasing trauma cases post the relaxation of lockdown and also in any subsequent waves of infection with newer strains. Simulation and periodic stringent audits with the entire team would prove successful in rectifying errors and avoiding any possible contamination.
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Affiliation(s)
- Anil K. Bhat
- Unit of Hand and Microsurgery, Department of Orthopaedics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, 576104, India
| | - Sandeep Vijayan
- Department of Orthopaedics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, 576104, India
| | - Ashwath M. Acharya
- Unit of Hand and Microsurgery, Department of Orthopaedics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, 576104, India
| | - Sourab Shetty
- Department of Orthopaedics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, 576104, India,Corresponding author.
| | - Nishanth Ampar
- Department of Orthopaedics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, 576104, India
| | - Madhava Pai Kanhangad
- Department of Orthopaedics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, 576104, India
| | - Nikhil Hegde
- Department of Orthopaedics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, 576104, India
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Fisher ND, Bi AS, Aggarwal V, Leucht P, Tejwani NC, McLaurin TM. A Level 1 Trauma Center's response to the COVID-19 pandemic in New York City: a qualitative and quantitative story. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 31:1451-1456. [PMID: 33616766 PMCID: PMC7897731 DOI: 10.1007/s00590-021-02902-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 02/08/2021] [Indexed: 01/28/2023]
Abstract
Background The purpose of this study is to describe a Level 1 Trauma Center’s orthopedic response to the COVID-19 pandemic, and to compare outcomes of acute fracture patients pre-COVID versus during the COVID-19 pandemic. Methods All inpatient fracture cases performed over a 5-month period were identified and retrospective chart review performed. Patients were divided into pre- and COVID-era groups based on when surgery was performed relative to March 16, 2020 (the date elective operations were ceased), and groups were statistically compared. Patients with a COVID test result were further sub-divided into COVID negative and positive groups, and statistically compared. Statistical analysis was performed using independent t-test for continuous variables and chi-square analysis for categorical variables. Results One hundred and nineteen patients were identified, 38% females with average age of 58 years. Average length of stay was 7 days with average time from injury to surgery of 3 days and average time from admission to surgery of 1.3 days. Overall in-hospital complication rate was 29.4%, and 30-day mortality and readmission rates were 2.5% and 5%, respectively. Sixty-nine patients comprised the pre-COVID group, and 50 in the COVID-era group. There was no significant difference with respect to length of stay, time from injury to surgery, time from admission to surgery, need for post-operative ICU stay, in-hospital complication rate, 30-day mortality rate and 30-day readmission rate. Thirty-four patients had COVID testing, with 24 negative and 10 positive. COVID-positive patients had longer time from injury to surgery (8.5 days vs. 2 days, p = 0.003) and longer time from admission to surgery (2.7 days vs. 1.2 days, p = 0.034). While more COVID-positive patients required ICU admission post-operatively (60% vs. 21%, p = 0.036), there was no difference in overall complication rate. Conclusions Orthopedic care of acute fracture patients was not affected by a global pandemic. The response of our Level 1 Trauma Center’s orthopedic department can guide other hospitals if and when new surges in COVID cases arise, in order to prevent compromising appropriate orthopedic care. Level of evidence Prognostic III.
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Affiliation(s)
- Nina D Fisher
- Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY, USA.
| | - Andrew S Bi
- Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Vinay Aggarwal
- Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY, USA.,Department of Orthopedic Surgery, Health and Hospitals, Bellevue, New York, NY, USA
| | - Philipp Leucht
- Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY, USA.,Department of Orthopedic Surgery, Health and Hospitals, Bellevue, New York, NY, USA
| | - Nirmal C Tejwani
- Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY, USA.,Department of Orthopedic Surgery, Health and Hospitals, Bellevue, New York, NY, USA
| | - Toni M McLaurin
- Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY, USA.,Department of Orthopedic Surgery, Health and Hospitals, Bellevue, New York, NY, USA
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13
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Liang ZC, Chong MSY, Liu GKP, Valle AGD, Wang D, Lyu X, Chang CH, Cho TJ, Haas SB, Fisher D, Murphy D, Hui JHP. COVID-19 and Elective Surgery: 7 Practical Tips for a Safe, Successful, and Sustainable Reboot. Ann Surg 2021; 273:e39-e40. [PMID: 32433295 PMCID: PMC7268862 DOI: 10.1097/sla.0000000000004091] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Zhen Chang Liang
- Department of Orthopaedic Surgery, National University of Singapore, National University Health System, Singapore
| | - Mark Seng Ye Chong
- Department of Orthopaedic Surgery, National University of Singapore, National University Health System, Singapore
| | - Gabriel Ka Po Liu
- Department of Orthopaedic Surgery, National University of Singapore, National University Health System, Singapore
| | | | - Dahui Wang
- National Children's Medical Center & Children's Hospital of Fudan University, Shanghai, People's Republic of China
| | - Xuemin Lyu
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Xicheng, People's Republic of China
| | - Chih-Hung Chang
- Department of Orthopaedic Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan; Graduate School of Biotechnology and Bioengineering, Yuan Ze University, Taoyuan, Taiwan
- Division of Infectious Disease, National University Hospital, Singapore
| | - Tae-Joon Cho
- Division of Paediatric Orthopaedics, Seoul National University College of Medicine, Seoul National University Children's Hospital, Seoul, Korea
| | | | - Dale Fisher
- Division of Infectious Disease, National University Hospital, Singapore
- Division of Paediatric Orthopaedics, Seoul National University College of Medicine, Seoul National University Children's Hospital, Seoul, Korea
| | - Diarmuid Murphy
- Department of Orthopaedic Surgery, National University of Singapore, National University Health System, Singapore
| | - James Hoi Po Hui
- Department of Orthopaedic Surgery, National University of Singapore, National University Health System, Singapore
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14
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Chen AZ, Shen TS, Bovonratwet P, Pain KJ, Murphy AI, Su EP. Total Joint Arthroplasty During the COVID-19 Pandemic: A Scoping Review with Implications for Future Practice. Arthroplast Today 2021; 8:15-23. [PMID: 33521188 PMCID: PMC7836630 DOI: 10.1016/j.artd.2020.12.028] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 12/14/2020] [Accepted: 12/21/2020] [Indexed: 11/13/2022] Open
Abstract
Background Recent studies have examined the impact of the COVID-19 pandemic on the practice of total joint arthroplasty. A scoping review of the literature with compiled recommendations is a useful tool for arthroplasty surgeons as they resume their orthopedic practices during the pandemic. Methods In June 2020, PubMed, Embase (Ovid), Cochrane Library (Wiley), Scopus, LitCovid, CINAHL, medRxiv, and bioRxiv were queried for articles using controlled vocabulary and keywords pertaining to COVID-19 and total joint arthroplasty. Studies were characterized by their region of origin, design, and Center of Evidence Based Medicine level of evidence. The identified relevant studies were grouped into 6 categories: changes to future clinical workflow, education, impact on patients, impact on surgeons, technology, and surgical volume. Results The COVID-19 pandemic has had a significant impact on arthroplasty practice, including the disruption of the clinical teaching environment, personal and financial consequences for patients and physicians, and the drastic reduction in surgical volume. New pathways for clinical workflow have emerged, along with novel technologies with applications for both patients and trainees. Conclusions The COVID-19 pandemic emphasizes the recent trend in arthroplasty toward risk stratification and outpatient surgery, which may result in improved clinical outcomes and significant cost-savings. Furthermore, virtual technologies are a promising area of future focus that may ultimately improve upon previous existing inefficiencies in the education and clinical environments.
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Affiliation(s)
- Aaron Z Chen
- Weill Cornell Medical College, New York, NY, USA
| | - Tony S Shen
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY, USA
| | - Patawut Bovonratwet
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY, USA
| | - Kevin J Pain
- Weill Cornell Medicine, Samuel J. Wood Library & C.V Starr Biomedical Information Center, New York, NY, USA
| | - Alexander I Murphy
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Edwin P Su
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY, USA
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15
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Clesham K, Hughes A, Feeley I, Sheehan E, Mohamed KMS. Challenges faced by orthopaedic trainees during the Covid-19 pandemic - An Irish perspective. Surgeon 2020; 19:e217-e221. [PMID: 33303375 PMCID: PMC7666556 DOI: 10.1016/j.surge.2020.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/31/2020] [Accepted: 10/13/2020] [Indexed: 11/24/2022]
Abstract
Background The recent SARS-CoV2/COVID-19 pandemic has caused a change in most aspects of our daily lives. Our health systems have had to adjust at an unprecedented rate to accommodate care for patients affected by the virus. As a result there has been widespread disruption to trauma and elective services throughout the Orthopaedic community Worldwide. We discuss the changes facing orthopaedic residents in training and the adaptations that have been made. Methods We discuss the challenges posed from a reduction in caseload to surgeons in training, teaching activities, patient interaction, workforce reinforcement and support networks in Ireland. Results A structured deployment of residents has taken place ensuring maximum exposure to operative cases to maintain competency. Teaching activities have been virtualised into a new curriculum that provides trainees with convenient access to a wide range of specialists at defined time periods during the week. Strategies have been employed to reinforce the workforce in anticipation of an acute reduction in staff due to the Covid-19 virus. Conclusions The changes have been rapid and despite many of these adjustments being borne out of necessity, the innovation displayed will almost certainly alter how training is ultimately delivered long after the crisis has ceased.
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Affiliation(s)
- Kevin Clesham
- Specialist Registrar in Trauma & Orthopaedic Surgery, Midland Regional Hospital, Tullamore, Co. Offaly, Ireland.
| | - Andrew Hughes
- Specialist Registrar in Trauma & Orthopaedic Surgery, Midland Regional Hospital, Tullamore, Co. Offaly, Ireland.
| | - Iain Feeley
- Specialist Registrar in Trauma & Orthopaedic Surgery, Midland Regional Hospital, Tullamore, Co. Offaly, Ireland.
| | - Eoin Sheehan
- Trauma & Orthopaedic Surgery, Midland Regional Hospital, Tullamore, Co. Offaly, Ireland; National Trauma & Orthopaedic Higher Surgical Training, Royal College of Surgeons, Ireland.
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16
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Clement ND, Hall AJ, Makaram NS, Robinson PG, Patton RFL, Moran M, Macpherson GJ, Duckworth AD, Jenkins PJ. IMPACT-Restart: the influence of COVID-19 on postoperative mortality and risk factors associated with SARS-CoV-2 infection after orthopaedic and trauma surgery. Bone Joint J 2020; 102-B:1774-1781. [PMID: 33249904 DOI: 10.1302/0301-620x.102b12.bjj-2020-1395.r2] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
AIMS The primary aim of this study was to assess the independent association of the coronavirus disease 2019 (COVID-19) on postoperative mortality for patients undergoing orthopaedic and trauma surgery. The secondary aim was to identify factors that were associated with developing COVID-19 during the postoperative period. METHODS A multicentre retrospective study was conducted of all patients presenting to nine centres over a 50-day period during the COVID-19 pandemic (1 March 2020 to 19 April 2020) with a minimum of 50 days follow-up. Patient demographics, American Society of Anesthesiologists (ASA) grade, priority (urgent or elective), procedure type, COVID-19 status, and postoperative mortality were recorded. RESULTS During the study period, 1,659 procedures were performed in 1,569 patients. There were 68 (4.3%) patients who were diagnosed with COVID-19. There were 85 (5.4%) deaths postoperatively. Patients who had COVID-19 had a significantly lower survival rate when compared with those without a proven SARS-CoV-2 infection (67.6% vs 95.8%, p < 0.001). When adjusting for confounding variables (older age (p < 0.001), female sex (p = 0.004), hip fracture (p = 0.003), and increasing ASA grade (p < 0.001)) a diagnosis of COVID-19 was associated with an increased mortality risk (hazard ratio 1.89, 95% confidence interval (CI) 1.14 to 3.12; p = 0.014). A total of 62 patients developed COVID-19 postoperatively, of which two were in the elective and 60 were in the urgent group. Patients aged > 77 years (odds ratio (OR) 3.16; p = 0.001), with increasing ASA grade (OR 2.74; p < 0.001), sustaining a hip (OR 4.56; p = 0.008) or periprosthetic fracture (OR 14.70; p < 0.001) were more likely to develop COVID-19 postoperatively. CONCLUSION Perioperative COVID-19 nearly doubled the background postoperative mortality risk following surgery. Patients at risk of developing COVID-19 postoperatively (patients > 77 years, increasing morbidity, sustaining a hip or periprosthetic fracture) may benefit from perioperative shielding. Cite this article: Bone Joint J 2020;102-B(12):1774-1781.
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Affiliation(s)
| | - Andrew James Hall
- Department of Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Navnit S Makaram
- Department of Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | - Robyn F L Patton
- Biomedical Sciences, Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Matthew Moran
- Department of Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | - Andrew D Duckworth
- Department of Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.,University of Edinburgh, Edinburgh, UK
| | - Paul J Jenkins
- Department of Orthopaedics, Glasgow Royal Infirmary, Glasgow, UK
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17
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Jensen RD, Bie M, Gundsø AP, Schmid JM, Juelsgaard J, Gamborg ML, Mainz H, Rölfing JD. Preparing an orthopedic department for COVID-19. Acta Orthop 2020; 91:644-649. [PMID: 32907437 PMCID: PMC8023962 DOI: 10.1080/17453674.2020.1817305] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - The COVID-19 pandemic has disrupted healthcare services around the world. We (1) describe the organizational changes at a level 1 trauma center, (2) investigate how orthopedic healthcare professionals perceived the immense amount of information and educational activities, and (3) make recommendations on how an organization can prepare for disruptive situations such as the COVID-19 pandemic in the future. Methods - We conducted a retrospective survey on the organizational restructuring of the orthopedic department and the learning outcomes of a needs-driven educational program. The educational activities were evaluated by a non-validated, 7-item questionnaire. Results - The hospital established 5 COVID-19 clusters, which were planned to be activated in sequential order. The orthopedic ward comprised cluster 4, where orthopedic nursing staff were teamed up with internal medicine physicians, while the orthopedic team were redistributed to manage minor and major injuries in the emergency department (ED). The mean learning outcome of the educational activities was high-very high, i.e., 5.4 (SD 0.7; 7-point Likert scale). Consequently, the staff felt more confident to protect themselves and to treat COVID-19 patients. Interpretation - Using core clinical competencies of the staff, i.e., redistribution of the orthopedic team to the ED, while ED physicians could use their competencies treating COVID-19 patients, may be applicable in other centers. In-situ simulation is an efficient tool to enhance non-technical and technical skills and to facilitate organizational learning in regard to complying with unforeseen changes.
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Affiliation(s)
- Rune Dall Jensen
- Corporate HR, MidtSim, Central Denmark Region, Aarhus
- Department of Clinical Medicine, Aarhus University, Aarhus
| | - Magnus Bie
- Corporate HR, MidtSim, Central Denmark Region, Aarhus
| | | | | | - Joachim Juelsgaard
- Department of Respiratory Disease and Allergy, Aarhus University Hospital
| | - Maria Louise Gamborg
- Corporate HR, MidtSim, Central Denmark Region, Aarhus
- Centre for Health Sciences Education, Aarhus University, Denmark
| | - Hanne Mainz
- Department of Orthopaedics, Aarhus University Hospital, Aarhus
| | - Jan Duedal Rölfing
- Corporate HR, MidtSim, Central Denmark Region, Aarhus
- Department of Clinical Medicine, Aarhus University, Aarhus
- Department of Orthopaedics, Aarhus University Hospital, Aarhus
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18
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Schaller G, Nayar SK, Erotocritou M, Overton A, Stelzhammer T, Berber O. Efficacy of surgical helmet systems for protection against COVID-19: a double-blinded randomised control study. INTERNATIONAL ORTHOPAEDICS 2020; 45:39-42. [PMID: 32895744 PMCID: PMC7476793 DOI: 10.1007/s00264-020-04796-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 09/01/2020] [Indexed: 12/02/2022]
Abstract
Purpose This study assesses whether sterile surgical helmet systems (SSHS) provide surgeons with additional protection from aerosol pathogens alongside their traditional role protecting against splash. There has been debate on whether to use such systems in reopening elective orthopaedic surgery during the current COVID-19 pandemic environment. Methods Thirty-five participants were enrolled in a double-blinded randomised controlled study investigating efficacy of the Stryker Flyte Surgical Helmet (Stryker Corporation, Kalamazoo, MI, USA) as protection against respiratory droplets. Wearing the SSHS in a fit testing hood, subjects were randomised to nebulised saccharin solution or placebo. Twenty were allocated to the saccharin group with 15 to placebo. Positive sweet taste represented a failure of the test. Taste tests were performed with the helmet fan turned on and off. Results SSHS did not prevent saccharin taste (p < 0.0001). Within the saccharin cohort, 40% recorded a positive taste with the fan on and 100% with the fan off. There was a statistically significant difference in mean time-to-taste saccharin (p = 0.049) comparing fan on (123.5 s) vs. off (62.6 s). Conclusions SSHS do not protect against aerosol particulate and therefore are not efficacious in protection against COVID-19. The fan system employed may even increase risk to the surgeon by drawing in particulates as well as delay recognition of intraoperative cues, such as exhaust from diathermy, that point to respirator mask leak.
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Affiliation(s)
- Gavin Schaller
- Trauma and Orthopaedics Department, Whittington Health NHS Trust, Magdala Avenue, London, N19 5NF, UK.
| | - Sandeep Krishan Nayar
- Trauma and Orthopaedics Department, Whittington Health NHS Trust, Magdala Avenue, London, N19 5NF, UK
| | - Marios Erotocritou
- Trauma and Orthopaedics Department, Whittington Health NHS Trust, Magdala Avenue, London, N19 5NF, UK
| | - Alexander Overton
- Trauma and Orthopaedics Department, Whittington Health NHS Trust, Magdala Avenue, London, N19 5NF, UK
| | - Thomas Stelzhammer
- Trauma and Orthopaedics Department, Whittington Health NHS Trust, Magdala Avenue, London, N19 5NF, UK
| | - Onur Berber
- Trauma and Orthopaedics Department, Whittington Health NHS Trust, Magdala Avenue, London, N19 5NF, UK
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19
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Das De S, Liang ZC, Cheah AEJ, Puhaindran ME, Lee EY, Lim AYT, Chong AKS. Emergency Hand and Reconstructive Microsurgery in the COVID-19-Positive Patient. J Hand Surg Am 2020; 45:869-875. [PMID: 32888437 PMCID: PMC7388858 DOI: 10.1016/j.jhsa.2020.07.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/25/2020] [Accepted: 07/27/2020] [Indexed: 02/02/2023]
Abstract
The case spectrum in hand surgery is one of extremes-purely elective day surgery cases under local anesthesia to mangling limb injuries that require immediate, and frequently, lengthy, surgery. Despite the cancellation of most elective orthopedic and plastic surgical procedures, hand surgeons around the world continue to see a steady stream of limb-threatening cases such as severe trauma and infections that require emergent surgical care. With the increase in community-spread, an increasing number of COVID-19-infected patients may be asymptomatic or have mild, nonspecific or atypical symptoms. Some of them may already have an ongoing, severe infection. The time-sensitive nature of some of these cases means that hand surgeons may need to operate urgently on patients who may be suspected of COVID-19 infections, often before confirmatory test results are available. General guidelines for perioperative care of the COVID-19-positive patient have been published. However, our practices differ from those of general orthopedic and plastic surgery, primarily because of the focus on trauma. This article discusses the perioperative and technical considerations that are essential to manage the COVID-19 patient requiring emergency care, without compromising clinical outcomes and while ensuring the safety of the attending staff.
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Affiliation(s)
- Soumen Das De
- Department of Hand and Reconstructive Microsurgery, National University Hospital, Singapore,Corresponding author: Soumen Das De, MBBs, MPH, National University Health System, 1E Kent Ridge Rd., Singapore 119228
| | - Zhen Chang Liang
- Department of Hand and Reconstructive Microsurgery, National University Hospital, Singapore
| | - Andre Eu-Jin Cheah
- Department of Hand and Reconstructive Microsurgery, National University Hospital, Singapore
| | - Mark Edward Puhaindran
- Department of Hand and Reconstructive Microsurgery, National University Hospital, Singapore
| | - Ellen Yutan Lee
- Department of Hand and Reconstructive Microsurgery, National University Hospital, Singapore
| | - Aymeric Yu Tang Lim
- Department of Hand and Reconstructive Microsurgery, National University Hospital, Singapore
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20
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Mitkovic MM, Bumbasirevic M, Milenkovic S, Gajdobranski D, Bumbasirevic V, Mitkovic MB. Influence of coronavirus disease 2019 pandemic state of emergency in orthopaedic fracture surgical treatment. INTERNATIONAL ORTHOPAEDICS 2020; 45:815-820. [PMID: 32728928 PMCID: PMC7389160 DOI: 10.1007/s00264-020-04750-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 07/23/2020] [Indexed: 12/23/2022]
Abstract
Purpose After the appearance of first COVID-19 cases in Serbia, state of emergency was declared on 15 March 2020 and lasted for 54 days. The aim of this report is to compare orthopaedic fracture frequencies in this period, when the walk was limited at the home mostly, with those during the same part in the previous year with regular state, thus to examine staying at home as a factor influencing the frequency of different fracture types. Methods There were 86 patients during the state of emergency in year 2020 and 106 patients during the same part of year 2019 with a regular state, having orthopaedic trauma surgery. Number of fractures, gender distribution, and age of patients have been compared between these periods. Results Total number of fractures decreased for about 19% during the state of emergency. There was nonsignificant difference in fracture frequency for all skeletal areas (p > 0.05), except for distal femoral fractures which occurred more often during the state of emergency (p < 0.05). Female ratio was higher during state of emergency than in regular state for femoral neck fractures. Conclusion Restricted going outside the home for 54 days has the influence in total number of fractures and gender distribution in femoral neck fractures. The method of external fixation used could be assumed as a reducing factor of intraoperative virus pandemic propagation among medical staff.
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Affiliation(s)
- Milan M Mitkovic
- Clinic for Orthopaedics and Traumatology, Clinical Center Nis, Nis, Serbia.
- Faculty of Medicine, University of Nis, Nis, Serbia.
| | - Marko Bumbasirevic
- Clinic for Orthopaedics and Traumatology, Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Sasa Milenkovic
- Clinic for Orthopaedics and Traumatology, Clinical Center Nis, Nis, Serbia
- Faculty of Medicine, University of Nis, Nis, Serbia
| | | | | | - Milorad B Mitkovic
- Clinic for Orthopaedics and Traumatology, Clinical Center Nis, Nis, Serbia
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21
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Dizdarevic A, Farah F. Perioperative management of elderly patients presenting with hip fracture during COVID-19 pandemic surge. J Clin Anesth 2020; 67:110014. [PMID: 32866731 PMCID: PMC7386783 DOI: 10.1016/j.jclinane.2020.110014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 06/12/2020] [Accepted: 07/25/2020] [Indexed: 11/11/2022]
Abstract
Patients with hip fracture and COVID-19 infection may have higher combined morbidity and mortality Universal testing with high level of clinical judgment should be used Appropriate timing of surgery vs non-surgical approach should be decided based on risk and severity of COVID-19 and underlying medical condition Universal contact and droplet as well as aerosol precautions, when needed, should be utilized Optimal surgery and anesthesia techniques should be chosen, with regional preferred over general anesthesia
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Affiliation(s)
- Anis Dizdarevic
- Montefiore Medical Center, Albert Einstein College of Medicine, Department of Anesthesiology, The Bronx, NY, USA.
| | - Fadi Farah
- Montefiore Medical Center, Albert Einstein College of Medicine, Department of Anesthesiology, The Bronx, NY, USA
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22
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Copper-Alloy Surfaces and Cleaning Regimens against the Spread of SARS-CoV-2 in Dentistry and Orthopedics. From Fomites to Anti-Infective Nanocoatings. MATERIALS 2020; 13:ma13153244. [PMID: 32707757 PMCID: PMC7435369 DOI: 10.3390/ma13153244] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 07/14/2020] [Accepted: 07/17/2020] [Indexed: 12/11/2022]
Abstract
The latest diffusion of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), responsible for the coronavirus disease (COVID-19), has involved the whole world population. Even if huge efforts to control the pandemic have been done, the viral spread is still continuing. COVID-19 is reported as a zoonosis jumped from bats and pangolins to humans. After infection in humans, SARS-CoV-2 is found in the nasopharyngeal and salivary secretions. The virus has also been detected in the blood plasma of infected patients. The viral spread occurs through droplets exhaled from the nose and mouth of the infected people when they breath or talk, or through droplets propelled as a dense cloud by chough or sneeze. The virus can also be delivered as an aerosol from blood plasma, through surgical procedures. Following these ways, the virus can disperse in the air, then reaching and settling on the exposed surfaces. How long the virus will survive on a surface depends on the material the surface is made from. Infection via high-touch surfaces should be prevented. Copper alloy coatings, combined with efficient hygienic/disinfectant procedures and careful surgical practice, could be helpful to health protection in dental practice and can also be adopted in orthopedic traumatology.
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23
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Orthopaedic surgery after COVID-19 - A blueprint for resuming elective surgery after a pandemic. Int J Surg 2020; 80:162-167. [PMID: 32679206 PMCID: PMC7362835 DOI: 10.1016/j.ijsu.2020.07.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 07/03/2020] [Indexed: 12/11/2022]
Abstract
Background The COVID-19 outbreak was fraught with danger and despair as many medically necessary surgeries were cancelled to preserve precious healthcare resources and mitigate disease transmission. As the rate of infection starts to slow, healthcare facilities and economies attempt to return to normalcy in a graduated manner and the massive pent-up demand for surgeries needs to eventually be addressed in a systematic and equitable manner. Materials and methods Guidelines from the Alliance of International Organizations of Orthopaedics and Traumatology, Orthopaedic Trauma Association, American College of Surgeons, American Society of Anaesthesiologists, Association of perioperative Registered Nurses, American Hospital Association, Centers for Medicare and Medicaid Services, World Health Organization and Centers for Disease Control and Prevention were evaluated and summarized into a working framework, relevant to orthopaedic surgeons. Results The guiding principles for restarting elective surgeries in a safe and acceptable manner include up-to-date disease awareness, projection and judicious management of equipment and facilities, effective human resource management, a fair and transparent system to prioritize cases, optimization of peri-operative workflows and continuous data gathering and clinical governance. Conclusion The world was ill prepared for the initial COVID-19 outbreak. However, with effective forward planning, institutions can ramp-up elective surgical caseload in a safe and equitable manner. As COVID-19 resolves, the pent-up demand for surgeries needs to be addressed in a systematic and equitable manner. Up-to-date disease awareness is necessary for projection and judicious management of equipment and facilities. Effective human resource management and optimization of peri-operative workflows will improve clearance of elective caseload. A fair and transparent system to prioritize cases is required to reduce patient confusion and vexation. Continuous data gathering and clinical governance ensures continuity of operative services in the event of a second wave.
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24
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Sitnik AA, Murzich AE, Volotovski PA, Gerasimenko MA. Trauma Care in COVID-19 Pandemic. TRAUMATOLOGY AND ORTHOPEDICS OF RUSSIA 2020. [DOI: 10.21823/2311-2905-2020-26-2-9-14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The development of COVID-19 pandemic is the serious challenge for trauma care systems across the world. Recommendations on general principles of trauma care in the settings of pandemic, medical stuff protection and prevention of the spread of infection based on the data from international centers are presented in the article. Delay of all elective cases, restriction of surgical treatment of fractures with relative indications for surgery are recommended. The segregation of cases into COVID-19 confirmed or suspected and COVID-19 negative patients is important. When possible before the admission to in-patient department the patient shall be tested on COVID-19. When the COVID-19 status of the patient is unclear all possible protection measures shall be used: patient isolation and medical stuff protection. To prevent the spread of infection it is recommended to split the stuff of the traumacenter into 2 or 3 groups. Each of the groups is working during the week with subsequent period of the self-isolation (remote work) for the period of 1-2 weeks (according to the duration of incubation period of the COVID-19). During the surgical treatment the most dangerous stages of the surgery are endotracheal intubation / extubation and also aerosol-generative procedures: electrocoagulation, pulsed wound lavage, drilling, the use of oscillating saw and medullary reaming. The stuff in the OP-theatre has to be accordingly equipped (personal protection equipment). The risk factors for the medical stuff are fatigue from overwork, the absence of real-time training in infection-prevention measures and non-compliance with PPE.
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Jerome JTJ, Mercier F, Mudgal CS, Arenas-Prat J, Vinagre G, Goorens CK, Rivera-Chavarría IJ, Sechachalam S, Mofikoya B, Thoma A, Medina C, Rivera-Chavarría IJ, Henry M, Afshar A, Dailiana ZH, Prasetyono TOH, Artiaco S, Madhusudhan TR, Ukaj S, Reigstad O, Hamada Y, Bedi R, Poggetti A, Al-Qattan MM, Siala M, Viswanathan A, Romero-Reveron R, Hong JP, Khalid KA, Bhaskaran S, Venkatadass K, Leechavengvongs S, Goorens CK, Nazim S, Georgescu AV, Tremp M, Nakarmi KK, Ellabban MA, Chan P, Aristov A, Patel S, Moreno-Serrano CL, Rai S, Kanna RM, Malshikare VA, Tanabe K, Thomas S, Gokkus K, Baek SH, Brandt J, Rith Y, Olazabal A, Saaiq M, Patil V, Jithendran N, Parekh H, Minamikawa Y, Atagawi AA, Hadi JA, Berezowsky CA, Moya-Angeler J, Altamirano-Cruz MA, Galvis R LA, Antezana A, Paczesny L, Fernandes CH, Asadullah M, Yuan-Shun L, Makelov B, Dodakundi C, Regmi R, Pereira GU, Zhang S, Sayoojianadhan B, Callupe I, Rakha MI, Papes D, Ganesan RP, Mohan M, Jeyaraman A, Prabhakar P, Rajniashokan A, Geethan I, Chandrasekar S, Löw S, Thangavelu K, Giudici LD, Palanisamy Y, Vaidyanathan S, Boretto J, Ramirez MA, Goundar TS, Kuppusamy T, Kanniyan K, Srivastava A, Chiu YC, Bhat AK, Gopinath NR, Vasudevan VP, Abraham V. Perspectives and Consensus among International Orthopaedic Surgeons during Initial and Mid-lockdown Phases of Coronavirus Disease. J Hand Microsurg 2020; 12:135-162. [PMID: 33408440 DOI: 10.1055/s-0040-1713964] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
With a lot of uncertainty, unclear, and frequently changing management protocols, COVID-19 has significantly impacted the orthopaedic surgical practice during this pandemic crisis. Surgeons around the world needed closed introspection, contemplation, and prospective consensual recommendations for safe surgical practice and prevention of viral contamination. One hundred orthopaedic surgeons from 50 countries were sent a Google online form with a questionnaire explicating protocols for admission, surgeries, discharge, follow-up, relevant information affecting their surgical practices, difficulties faced, and many more important issues that happened during and after the lockdown. Ten surgeons critically construed and interpreted the data to form rationale guidelines and recommendations. Of the total, hand and microsurgery surgeons (52%), trauma surgeons (32%), joint replacement surgeons (20%), and arthroscopy surgeons (14%) actively participated in the survey. Surgeons from national public health care/government college hospitals (44%) and private/semiprivate practitioners (54%) were involved in the study. Countries had lockdown started as early as January 3, 2020 with the implementation of partial or complete lifting of lockdown in few countries while writing this article. Surgeons (58%) did not stop their surgical practice or clinics but preferred only emergency cases during the lockdown. Most of the surgeons (49%) had three-fourths reduction in their total patients turn-up and the remaining cases were managed by conservative (54%) methods. There was a 50 to 75% reduction in the number of surgeries. Surgeons did perform emergency procedures without COVID-19 tests but preferred reverse transcription polymerase chain reaction (RT-PCR; 77%) and computed tomography (CT) scan chest (12%) tests for all elective surgical cases. Open fracture and emergency procedures (60%) and distal radius (55%) fractures were the most commonly performed surgeries. Surgeons preferred full personal protection equipment kits (69%) with a respirator (N95/FFP3), but in the case of unavailability, they used surgical masks and normal gowns. Regional/local anesthesia (70%) remained their choice for surgery to prevent the aerosolized risk of contaminations. Essential surgical follow-up with limited persons and visits was encouraged by 70% of the surgeons, whereas teleconsultation and telerehabilitation by 30% of the surgeons. Despite the protective equipment, one-third of the surgeons were afraid of getting infected and 56% feared of infecting their near and dear ones. Orthopaedic surgeons in private practice did face 50 to 75% financial loss and have to furlough 25% staff and 50% paramedical persons. Orthopaedics meetings were cancelled, and virtual meetings have become the preferred mode of sharing the knowledge and experiences avoiding human contacts. Staying at home, reading, and writing manuscripts became more interesting and an interesting lifestyle change is seen among the surgeons. Unanimously and without any doubt all accepted the fact that COVID-19 pandemic has reached an unprecedented level where personal hygiene, hand washing, social distancing, and safe surgical practices are the viable antidotes, and they have all slowly integrated these practices into their lives. Strict adherence to local authority recommendations and guidelines, uniform and standardized norms for admission, inpatient, and discharge, mandatory RT-PCR tests before surgery and in selective cases with CT scan chest, optimizing and regularizing the surgeries, avoiding and delaying nonemergency surgeries and follow-up protocols, use of teleconsultations cautiously, and working in close association with the World Health Organization and national health care systems will provide a conducive and safe working environment for orthopaedic surgeons and their fraternity and also will prevent the resurgence of COVID-19.
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Affiliation(s)
- J Terrence Jose Jerome
- Department of Orthopedics, Hand and Reconstructive Microsurgery, Olympia Hospital and Research Centre, Tamil Nadu, India
| | | | - Chaitanya S Mudgal
- Harvard Medical School, Massachusetts, United States; Hand Surgery Services, Massachusetts General Hospital, Boston, Massachusetts, United States.,Hand Surgery Service, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Joan Arenas-Prat
- Department of Orthopaedics, ServeisMedics Penedes, Barcelona, Catalonia, Spain
| | - Gustavo Vinagre
- Department of Orthopaedic Surgery, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Chul Ki Goorens
- Department of Orthopaedics, Regional Hospital Tienen, Tienen, Belgium
| | | | | | - Bolaji Mofikoya
- Department of Surgery, College of Medicine, University of Lagos, Lagos, Nigeria
| | | | | | | | | | | | - Ahmadreza Afshar
- Department of Orthopedics, Imam Khomeini hospital, Urmia University of Medical Sciences, Urmia, Iran
| | - Zoe H Dailiana
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Theddeus O H Prasetyono
- Department of Surgery, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | | | | | | | - Ole Reigstad
- Hand Surgery Unit, Oslo University Hospital, Oslo, Norway
| | - Yoshitaka Hamada
- Hand Surgery Unit, Kansai Medical University Medical Center, Moriguchi City, Osaka, Japan
| | | | - Andrea Poggetti
- Hand and Reconstructive Microsurgery Unit, AOU Careggi, Florence, Italy
| | | | - Mahdi Siala
- Service d'Orthopedie, chu de purpan, Toulouse, France
| | | | - Rafael Romero-Reveron
- Trauma and Orthopaedic Departamento, Centro Médico Docente La Trinidad, Caracas, Venezuela
| | - Joon Pio Hong
- Hand and Reconstructive Microsurgery Unit, Asan Medical Center, Songpagu Seoul, Korea
| | - Kamarul Ariffin Khalid
- Department of Orthopedics, IIUM Medical Centre, Jalan Sultan Ahmad Shah, Kuantan, Pahang, Malaysia
| | | | | | | | - Chul Ki Goorens
- School of Medicine, China Medical University, Taichung, Taiwan
| | - Sifi Nazim
- Department of Orthopaedics, Algiers Faculty of Medicine, Algiers, Algeria
| | | | - Mathias Tremp
- Department of Orthopaedics, Dorfplatz 1, Cham, Switzerland
| | | | - Mohamed A Ellabban
- Plastic and Reconstructive Surgery Unit, Department of Surgery, Faculty of Medicine, Suez Canal University, Egypt
| | - Pingtak Chan
- Department of Orthopaedics and Traumatology, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | | | | | | | | | | | | | - Katsuhisa Tanabe
- Department of Orthopaedics, Nishinomiya Municipal Central Hospital, Hayashidacho, Nishinomiya, Japan
| | - Simon Thomas
- Department of Ort hopaedics, Rohini, Delhi, India
| | - Kemal Gokkus
- Alanya Research and Practice Center, Baskent University School of Medicine, Saray Mah, Antalya, Turkey
| | - Seung-Hoon Baek
- Department of Orthopedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
| | | | - Yin Rith
- Department of Orthopaedics, Cambodia
| | | | - Muhammad Saaiq
- Department of Hand Surgery, National Institute of Rehabilitation Medicine (NIRM), Islamabad, Pakistan
| | - Vijay Patil
- Orthopedics, Hand and Microsurgery Unit, Basildon Unive rsity Hospital, Basildon, Essex, United Kingdom
| | | | | | | | | | | | | | | | | | | | | | - Lukasz Paczesny
- Orvit Clinic, Citomed Healthcare Center, Sklodowskiej, Torun, Poland
| | | | - Md Asadullah
- Orthopedics and Hand surgery Unit, Eman Medical College Hospital, Savar, Dhaka, Bangladesh
| | | | | | | | - Rabindra Regmi
- Department of Orthopedics and Reconstructive Microsurgery, National Trauma Centre, Kathmandu, Nepal
| | | | - Shuwei Zhang
- Department of Spine and Bone Tumor Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Binoy Sayoojianadhan
- Hand and Reconstructive Microsurgery Unit, Department of Orthopedic Surgery, St James Hospital, Chalakudy, Kerala, India
| | | | - Mohamed I Rakha
- Orthopedic Department, Suez Canal university hospital, Ismailia, Egypt
| | - Dino Papes
- Department of surgery (Ped and Vasc), University Hospital Center Zagreb, Zagreb, Croatia
| | - Ramesh Prabu Ganesan
- Department of Orthopedics, KAP Viswanatham Government Medical College, Trichy, India
| | | | | | - Ponnaian Prabhakar
- Orthopaedics and Joint Replacement Care Hospitals, Nampally Hyderabad, India
| | | | | | | | - Steffen Löw
- Clinic for Trauma and Hand Surgery, Bad Mergentheim, Germany
| | | | - Luca Dei Giudici
- Ortopedia e Traumatologia, Chirurgiaarticolare di Spalla e Ginocchio, Albodei Medici e Chirurghi di Latina, Cagliari, Italy
| | | | | | | | | | | | - Thirumavalavan Kuppusamy
- Department of Orthopedics, Trauma and Joint Replacement, Shri Bharani Hospital, Villupuram, Tamil Nadu, India
| | | | | | - Yung-Cheng Chiu
- Department of Orthopedic Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Anil K Bhat
- Department of Orthopaedics, KMC, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | | | | | - Vineet Abraham
- Department of Orthopaedics, Mahatma Gandhi Medical College, Pondicherry, India
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Liow MHL, Tay KXK, Yeo NEM, Tay DKJ, Goh SK, Koh JSB, Howe TS, Tan AHC. From "business continuity" to "back to business" for orthopaedic surgeons during the COVID-19 pandemic. Bone Jt Open 2020; 1:222-228. [PMID: 33225293 PMCID: PMC7677721 DOI: 10.1302/2633-1462.16.bjo-2020-0036.r1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has led to unprecedented challenges to healthcare systems worldwide. Orthopaedic departments have adopted business continuity models and guidelines for essential and non-essential surgeries to preserve hospital resources as well as protect patients and staff. These guidelines broadly encompass reduction of ambulatory care with a move towards telemedicine, redeployment of orthopaedic surgeons/residents to the frontline battle against COVID-19, continuation of education and research through web-based means, and cancellation of non-essential elective procedures. However, if containment of COVID-19 community spread is achieved, resumption of elective orthopaedic procedures and transition plans to return to normalcy must be considered for orthopaedic departments. The COVID-19 pandemic also presents a moral dilemma to the orthopaedic surgeon considering elective procedures. What is the best treatment for our patients and how does the fear of COVID-19 influence the risk-benefit discussion during a pandemic? Surgeons must deliberate the fine balance between elective surgery for a patient’s wellbeing versus risks to the operating team and utilization of precious hospital resources. Attrition of healthcare workers or Orthopaedic surgeons from restarting elective procedures prematurely or in an unsafe manner may render us ill-equipped to handle the second wave of infections. This highlights the need to develop effective screening protocols or preoperative COVID-19 testing before elective procedures in high-risk, elderly individuals with comorbidities. Alternatively, high-risk individuals should be postponed until the risk of nosocomial COVID-19 infection is minimal. In addition, given the higher mortality and perioperative morbidity of patients with COVID-19 undergoing surgery, the decision to operate must be carefully deliberated. As we ramp-up elective services and get “back to business” as orthopaedic surgeons, we have to be constantly mindful to proceed in a cautious and calibrated fashion, delivering the best care, while maintaining utmost vigilance to prevent the resurgence of COVID-19 during this critical transition period. Cite this article: Bone Joint Open 2020;1-6:222–228.
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Affiliation(s)
| | - Kenny Xian Khing Tay
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | | | - Darren Keng Jin Tay
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Seo Kiat Goh
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Joyce Suang Bee Koh
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Tet Sen Howe
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Andrew Hwee Chye Tan
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
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Tan KA, Thadani VN, Chan D, Oh JYL, Liu GKP. Addressing Coronavirus Disease 2019 in Spine Surgery: A Rapid National Consensus Using the Delphi Method via Teleconference. Asian Spine J 2020; 14:373-381. [PMID: 32403894 PMCID: PMC7280919 DOI: 10.31616/asj.2020.0224] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 05/07/2020] [Indexed: 12/15/2022] Open
Abstract
The magnitude and potential duration of the current coronavirus disease 2019 (COVID-19) pandemic is something that most doctors currently in practice have yet to experience. While considerable information regarding COVID-19 is being published every day, it is challenging to filter out the most relevant or appropriate information for our individual practice. The Spine Society of Singapore convened via a teleconference on April 24, 2020 to collaborate on a national level and share collective wisdom in order to tackle the ongoing crisis. In the teleconference, 13 spine surgeons from across various hospitals in Singapore constituted the panel of experts. The following topics were discussed: repurposing of surgeons, continuity of spine services, introduction of telemedicine, triaging of spinal surgeries, preoperative testing, new challenges in performing spine surgery, and preparing for the post-pandemic era. While some issues required only the sharing of best practices, the Delphi panel method was adopted to form a consensus on others. Existing spine specific triage guidelines were debated and a locally accepted set of guidelines was established. Although preoperative testing is currently not performed routinely, the panel voted in favor of its implementation because they concluded that it is vital to protect themselves, their colleagues, and their patients. Solutions to operating room specific concerns were also discussed. This article reflects the opinions and insights shared during this meeting and reviews the evidence relevant to the issues that were raised. The rapid consensus reached during the teleconference has enabled us to be concerted, and thus stronger, in our national efforts to provide the best standard of care via our spine services in these challenging times. We believe that this article will provide some guidance for addressing COVID-19 in spine surgery and encourage other national/regional societies to conduct similar discussions that would help their navigation of this pandemic.
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Affiliation(s)
- Kimberly-Anne Tan
- University Orthopaedics, Hand and Reconstructive Microsurgery (UOHC), National University Health System, Singapore
| | - Vishaal Nanik Thadani
- University Orthopaedics, Hand and Reconstructive Microsurgery (UOHC), National University Health System, Singapore
| | - Daniel Chan
- Department of Orthopaedic Surgery, Sengkang General Hospital, Singapore
| | | | - Gabriel Ka-Po Liu
- University Orthopaedics, Hand and Reconstructive Microsurgery (UOHC), National University Health System, Singapore
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Öztürk K, Ünkar EA, Öztürk AA. Perioperative management recommendations to resume elective orthopaedic surgeries for post-COVID-19 "new normal": Current vision of the Turkish Society of Orthopaedics and Traumatology. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2020; 54:228-233. [PMID: 32544059 DOI: 10.5152/j.aott.2020.20183] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Kahraman Öztürk
- Department of Hand Surgery, University of Health Sciences Baltalimanı Bone Diseases Training and Research Hospital, İstanbul, Turkey
| | - Ethem Ayhan Ünkar
- Department of Hand Surgery, University of Health Sciences Baltalimanı Bone Diseases Training and Research Hospital, İstanbul, Turkey
| | - Ahmet Alperen Öztürk
- Department of Orthopaedics and Traumatology, University of Health Sciences Prof. Dr. Cemil Taşçıoğlu City Hospital, İstanbul, Turkey
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Shanmugasundaram S, Vaish A, Vaishya R. Challenges in providing surgical care during and after COVID-19 pandemic. APOLLO MEDICINE 2020. [DOI: 10.4103/am.am_69_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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