Effect of COVID-19 on surgical management of open fractures and infection rates: A tertiary care experience in Indian set-up

Influence of COVID-19 pandemic on hospitalisations at a paediatric traumatology department during 2020: a single-centre observational study and comprehensive literature review

PURPOSE

The study investigates changes in the injury characteristics of hospitalised children in a paediatric trauma centre during the COVID-19 pandemic.

METHODS

Data from injured children from the pre-pandemic year 2019 were compared to the pandemic year 2020 using Pearson's chi-squared test and the Mann-Whitney U test. The period of highly restrictive regulations (HRP) was evaluated separately. A comprehensive literature review with defined search terms resulted in a descriptive data synthesis.

RESULTS

Data from 865 patients indicated reductions in admissions of 5.6% and 54.4% during the HRP. In 2020, the hospitalisation time was longer (2.2 ± 2.7 days in 2019 vs. 2.4 ± 2.6 in 2020, p = 0.045); the proportions of wounds requiring surgical therapy (p = 0.008) and of observational treatments, primarily for mild brain injuries (p = 0.046), were higher; and conservative treatments, primarily for contusions, were lower (p = 0.005). There were no significant changes in age, location of lesions, or frequency of surgical therapy; nor were there differences in the HRP, except for fewer injuries in school and kindergarten (p < 0.001). The literature review summarises the main results of 79 studies.

CONCLUSION

Limited resources did not alter the indications for surgical therapy. Further studies should examine whether the more common injuries sustained at home were caused by excessive work/childcare demands on parents. Reduced inpatient conservative treatment implies that hospital resources possibly were overused previously. The literature offers answers to many detailed questions regarding childhood injuries during a pandemic and more efficient safe treatment. Registration Ethical committee of RWTH Aachen University EK 22-320; Center for Translational & Clinical Research RWTH Aachen University (CTC-A) 21-430.

Changes in trends of orthopedic services due to the COVID-19 pandemic: A review

As of June 10, 2022, the World Health Organization has recorded over 532 million documented coronavirus disease 2019 (COVID-19) [(Coronavirus) SARS-CoV-2] cases and almost 6.3 million deaths worldwide, which has caused strain on medical specialties globally. The aim of this review is to explore the impact that COVID-19 has had on orthopedic practices. Providers observed a rapid decline in the number of orthopedic patients’ admissions due to cancellation of elective procedures; however, emergent cases still required treatment. Various observational studies, case reports, and clinical trials were collected through a PubMed database search. Additional sources were found through Google. The search was refined to publications in English and between the years of 2019 and 2021. The keywords used were “COVID-19” and/or “Orthopedic Injuries”. Thirty-seven studies were retained. The pandemic brought on significant changes to the mechanism of injury, number of admissions, type of injuries, and patient outcomes. Mortality rates significantly increased particularly amongst patients with hip fractures and COVID-19. Road traffic injuries remained a common cause of injury and domestic injuries became more prevalent with lockdown. Social isolation negatively affected mental health resulting in several orthopedic injuries. Telehealth services and separation for COVID-positive and COVID-negative patients benefited both patients and providers. While hospitals and medical facilities are still facing COVID-19 case surges, it is important to understand how this pandemic has impacted preparation, care, and opportunities for prevention education and ongoing care.

Use of external fixators in developing countries: a short socioeconomic analysis

The use of external fixators (EFs) dates back to 377 BC Hippocrates’ time, and it has a wide range of orthopaedic applications. External fixator has expanded its use in the management of fractures and other musculoskeletal conditions. It is widely used all over the world to manage complex musculoskeletal injuries. It has many advantages as compared to internal fixation in some trauma scenarios. However, the cost of the external fixators presents a dilemma to the healthcare system in developing countries. The goals of this review article are to explain the importance of EFs in developing countries in managing fractures, to determine the problems encountered at present during external fixation by developing countries, to identify solutions that could be used to address these issues, expand the use of external fixation into other domains of treatment, the impact of COVID-19 pandemic on fracture management based on existing literature. In conclusion, EFs are very expensive, researches have been conducted to overcome these barriers in developing countries. However, there are limitations in implementing in developing countries. It is important to have affordable and clinically acceptable EFs available in developing countries.

The Impact of COVID-19 Pandemic on Orthopedic Trauma Practice: An Experience at a Tertiary Care Center in Northern India

The Impact of Covid -19 Pandemic on Orthopedic trauma practice: An experience at a tertiary care center in Northern India Introduction: COVID-19 pandemic and associated lockdown have had drastic effects on the health care system. To dedicate all the staff, residents, interns to covid care and accommodate the escalated inflow of infected persons, most hospitals had to restructure their departments. The orthopedic department was no exception. The present study aimed to evaluate trends in orthopedic trauma cases during two waves of the Covid -19 pandemic.

MATERIAL AND METHODS

In this retrospective observational study, the period of lockdown during the first wave of Covid (March 24, 2020, to May 31, 2020 (Period 2)) and the second wave in 2021 was compared with a similar nine weeks interval in 2019 before COVID -19 (Period 1). Demographic details and epidemiological parameters of trauma were collected and compared.

OBSERVATIONS

The number of admissions declined from 8.2 admissions/day to 2.3/day and 2.71/day in periods 2 and 3, respectively. Roadside accidents in 73.37% of patients in period 1 reduced to 30.43% and 59 36.2% in period 2 and 3, respectively. After soft tissue injuries, fractures around the hip joint dominated the pattern of injury during the lockdown, while polytrauma significantly decreased compared to the pre-covid era. More than 80% of patients during lockdown were treated conservatively.

CONCLUSION

Evaluation of differences in injury patterns and method of treatment during distinctive situations arising due to the COVID-19 pandemic will help to judicially plan and formulate protocols for more effective management of patients if similar events arise again.

Epidemiologic characteristics and pre-hospital care of traumatic injuries during the COVID-19 pandemic in an emerging and developing country: A single tertiary centre experience

BACKGROUND

Pre-hospital care has been shown to reduce the mortality in trauma patients. The present study is an attempt to identify the status of pre-hospital orthopaedic trauma care in developing countries during COVID-19 pandemic.

METHODS

This was a prospective observational study carried out in a tertiary care setup from March 25th^, 2020 to January 31st^, 2021. All the data pertaining to the traumatic injuries including demographic details and epidemiologic characteristics were recorded in an electronic database.

RESULTS

A total of 1044 patients were included in the study for evaluation. The mean age was 35.24 ± 19.84 years. There were 873 males and 171 females. A total of 748 presented from nearby states, with 401 being the referrals and 347 cases coming directly to hospital. A total of 141 open fractures presented directly and 269 were referred from nearby states. Out of 269 cases of open fractures, only 67 and 139 were given intravenous antibiotics and had wound dressing done respectively at the periphery site. A total of 125, 112, 92 and 84 patients were received without traction/splintage, intravenous fluids, dose of analgesics and recording of vitals respectively. Delay from injury to presentation in emergency/administration of antibiotic (Hours) was 7.06. Road side accidents were main cause comprising of 52.58% cases. Gustilo Anderson classification grade-2 comprised of majority of the open fractures (51.63%). Lower limb fractures comprised of majority of the injuries (70.59%). Majority were adults and conservative management was the most common mode of treatment. A total of 197 and 265 patients had associated head injuries and blunt trauma chest/blunt trauma abdomen respectively.

CONCLUSION

Emphasizing on pre-hospital care measures, with special focus on co-ordination between primary, secondary and tertiary health care facilities is the need of the hour and can prevent additional morbidities, avoiding overburden of the already compromised healthcare centres.