Impact of COVID-19 on Clinical Practices during Lockdown: A pan India Survey of Orthopaedic Surgeons

@#Introduction: The social lockdown measures imposed to contain the COVID-19 pandemic, have had profound effects on the healthcare systems across the world and India has been no exception to it. The study was aimed to evaluate the impact of COVID-19 on orthopaedic practice in India during the lockdown period and assess the preparedness of orthopaedic surgeons for resuming clinical practice after the initial lockdown was lifted. Materials and Methods: An online survey of 35 questions was conducted to evaluate impact on (i) general orthopaedic practice (ii) hospital protocols (iii) out-patient practice (iv) surgical practice (v) personal protective equipment (PPE) use and (vi) post-lockdown preparedness. Results: A total number of 588 practising orthopaedic surgeons from India completed the survey. Majority (88.3%) found severe impact (>50%) on trauma surgery and nontrauma surgery with significant reduction in out -patient attendance compared to corresponding time in 2019. There were significant changes made in individual hospital protocols (91.7 %). Appropriate required PPE was available in majority of the hospitals (74.3%). No remodelling or upgrading of the existing operating theatre infrastructure was done by most surgeons (89.5%). Conclusion: This pan India survey of orthopaedic surgeons has indicated that COVID-19 has had a profound impact on their outpatient and surgical trauma and non-trauma practice, due to the lockdown and resulted in significant changes to hospital protocols. Preparedness to resume clinical and surgical practice was associated with anxiety in two-thirds of the respondents. Majority of the orthopaedic practitioners felt that they would continue to conduct pre-operative COVID-19 screening and use PPE even after the lockdown is over.

Anatomical study and morphometric analyses on the femoral insertions of the posterior cruciate ligament

PURPOSE: To provide an anatomical and morphometric basis for the femoral insertions of the posterior cruciate ligament (PCL) in order to aid in the creation of anatomical femoral tunnels in ligament surgical reconstruction. Study design: laboratory controlled study. MATERIAL AND METHODS: The macroscopic details of the femoral insertions of the PCL's anterolateral (AL) and posteromedial (PM) bundles were analyzed in 24 cadaver knees. The specimens were photographed with a digital camera and the images obtained were studied using the software ImageJ. The bundles' insertion areas were measured in square millimeters, and the length of the structures and the distances between significant points were measured in millimeters. RESULTS: The PCL's femoral insertion average total area was 87.29 ± 31.42 mm².The mean insertion's areas of the AL and PM bundles were, respectively, 47.13 ± 19.14 and 40.67 ± 16.19 mm². In 95.8% of the examined knees was verified the presence of the medial intercondylar ridge and in 83.3% of the knees was noted the medial bifurcated ridge. The average length of the medial intercondylar ridge was 20.54 ± 2.26 mm and the medial bifurcated ridge's average length was 7.62 ± 2.35 mm. CONCLUSIONS: The AL had a femoral insertion area larger than the PM bundle; these bundles' insertion areas were lower than those previously described in the literature. There were important individual variations related to the area of the bundles in the samples, suggesting that there should be an individual recommendation for anatomical reconstructions of the PCL with single or double femoral tunnels. .

Infecção de sítio cirúrgico em pacientes submetidos a cirurgias ortopédicas em um hospital público de Minas Gerais / Surgical site infection in patients submitted to orthopaedic surgery at a public hospital in the state of Minas Gerais / Infeccion del sitio quirurgico en pacientes sometidos a cirurgia ortopedica en un hospital publico del estado de Minas Gerais

Estudo de coorte histórica sobre infecções do sítio cirúrgico decorrentes das 3.543 cirurgias de pacientes ortopédicos constantes nos registros de banco de dados do Serviço de Controle de Infecção Hospitalar de um hospital geral, público e de grande porte de Minas Gerais. Os objetivos foram determinar a taxa de incidência de infecção de sítio cirúrgico e o tempo de manifestação da infecção, verificar a associação entre infecção e fatores de risco e identificar os microrganismos prevalentes. Encontrou-se a incidência de infecção de sítio cirúrgico de 1,8%. As variáveis potencial de contaminação da ferida cirúrgica, condições clínicas do paciente (ASA), duração da cirurgia e tipo de procedimento mostraram-se estatisticamente associadas à ISC. O tempo médio de manifestação das infecções após a cirurgia foi de 96 dias. O microrganismo mais frequente foi o Staphylococcus aureus.

This is a historic cohort study on surgical site infection occurred in 3,543 operations in orthopaedic patients. The surgical interventions were registered in the database of the Nosocomial Infection Control System of a Public General Hospital in Minas Gerais. Its objectives were to determine the incidence rate of surgery site infection, to verify the association between surgical site infection and some risk factors, to identify the prevalent microorganisms as well as the time for the infection's symptoms manifestation. The incidence rate of surgical site infection was 1.8%. The potential surgery wound infection, the patient's clinical condition (ASA), the surgery duration and the type of procedure were the variables statistically associated with SSI. After surgery the average time to the manifestation of infection was 96 days. The prevalent microorganism was Staphylococcus aureus.

Estudio tipo cohorte histórica sobre las infecciones de la herida quirúrgica como consecuencia de la cirugía ortopédica de 3543 pacientes incluidos en los registros de base de datos del Departamento de Control de Infecciones de un hospital general público de Belo Horizonte, Minas Gerais. Los objetivos fueron determinar la incidencia de la infección del sitio quirúrgico, determinar la asociación entre la infección y factores de riesgo, determinar el momento de aparición de la infección e identificar los microorganismos más prevalentes. Se ha encontrado una incidencia de infección del sitio quirúrgico de 1,8%. Las variables: potencial de contaminación de la herida quirúrgica, las condiciones clínicas del paciente (ASA), tiempo quirúrgico y tipo de procedimiento fueron estadísticamente asociados con la ISC. La infección se manifiesta en un plazo promedio de 96 días después de la cirugía. El microorganismo más frecuentes fue el Staphylococcus aureus.

Clinical application of trephine for arthrodesis of the ankle via lateral approach / 中国矫形外科杂志

[Objective]To introduce a new technique of ankle arthrodesis with trephine by lateral approach and evaluate its clinical effects.[Method]Ankle arthrodesis with trephine was performed in 20 patients with serious lesions.Lateral incision was adopted and osteotomy of fibula facilitated the exposure of the fusion site.A trephine of appropriate diameter was used for bi-osteotomy,thus inside the trephine gaining two bone blocks were then rotated 90? and replanted in situ.The pruned fibula was fixed with screws as on-lay!grafting.Proper cast was utilized postoperatively to maintain a functional position.[Result]The average follow-up period was 26 months(ranged from 6 months to 4 years).All the wounds healed well at 2 weeks and the callus appeared 4 weeks postoperatively.Sufficient pain relief was obtained in all patients at 12 weeks and appearance improved greatly.A solid union was achieved in all cases through the radiograph.[Conclusion]The use of trephine in ankle fusion by lateral approach is proved to be a simple technique with high union rate.The main advantages of the technique over other methods of arthrodesis include: excellent exposure by regular incision;less disturbance of the original joint,thereby preserving normal height of the joint and length of the extremity;no need for extra graft through in-situ grafting of the bone blocks and rigid on-lay grafting of lateral malleolus for high primary stability.