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@#Introduction: COVID-19 has had a significant impact on the entire health system. The trauma and orthopaedic service has been compelled to alter working practices to respond proactively and definitively to the crisis. The aim of this study is to summarise the impact of this outbreak on the trauma and orthopaedic workload and outline the response of the department. Materials and Methods: We retrospectively collected data comparing patient numbers pre-COVID-19, and prospectively during the early COVID-19 pandemic. We have collected the numbers and nature of outpatient orthopaedic attendances to fracture clinics and elective services, inpatient admissions and the number of fracture neck of femur operations performed. Results: The number of outpatient attendances for a musculoskeletal complaint to Accident and Emergency and the number of virtual fracture clinic reviews reduced by almost 50% during COVID-19. The number of face-to-face fracture clinic follow-ups decreased by around 67%, with a five-fold increase in telephone consultations. Inpatient admissions decreased by 33%, but the average number of fracture neck of femur operations performed has increased by 20% during COVID-19 compared to pre-COVID-19 levels. Conclusion: We have noted a decrease in some aspects of the trauma and orthopaedic outpatient workload, such as leisure and occupational-related injuries but an increase in others, such as fracture neck of femurs. Many injuries have significantly reduced in numbers and we consider that a model could be developed for treating these injuries away from the acute hospital site entirely, thereby allowing the acute team to focus more appropriate major trauma injuries.
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PURPOSE: The prognosis of ipsilateral supraclavicular lymph node (SCLN) recurrence after early breast cancer appears to be worse than for other locoregional recurrences, but better than for distant metastases. Prophylactic radiotherapy (RT) to supraclavicular region decreases risk of ipsilateral SCLN recurrence. Currently, all patients with locally advanced breast cancer are considered high‑risk for SCLN metastasis and treated with prophylactic RT. This study is carried out to identify risk factors associated with occult SCLN metastases in locally advanced breast cancer. MATERIALS AND METHODS:Total 48 female patients of all ages presenting with locally advanced carcinoma of breast who were operable by protocol criteria were included in the study. All the patients underwent modified radical mastectomy with supraclavicular lymphnode dissection. The resected specimen was processed for the histopathological analysis. RESULTS: Occult SCLN metastases are found in 25% (12/48) of the patients in this study. Eleven factors were identified and analyzed to know whether or not they are associated with SCLN metastasis. Of those only pathological N stage (7% for <pN3 vs and 52% for pN3 stage) and level axillary nodal involvement (7% for patients without Level III involvement and 52% for with Level III involvement) are significantly associated with high‑risk for occult supraclavicular lymphnode metastasis. Other factors such as age, menopausal status, T stage, pathologic grade, lymphovascular invasion, extracapsular extension, hormone receptor, and Her2 neu receptor status are not associated with risk for SCLN metastasis. CONCLUSION: Our study has shown that only high axillary disease burden in terms of more than 10 node positivity or more than 75% positive node out of total dissected nodes is associated with occult supraclavicular lymphnode metastasis breast cancer.