Paraparesis and congenital severe hyperkyphosis in Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome: A rare deformity management during the Sars-Cov-2 pandemic.

Introduction: Mayer-Rokitansky-Küster-Hauser syndrome (MRKH) syndrome can be classified into two types: type I (isolated) without extragenital abnormalities; type II (associated) with the presence of extragenital dimorphisms. Skeletal abnormalities are the second most frequent extragenital manifestations. Research question: Association between MRKH and congenital scoliosis has been described; on the contrary, hyperkyphosis is very rare and sparsely described in the medical literature. Here we report our experience in the management of thoracolumbar hyperkyphosis in 16-year-old patient diagnosed with MRKH syndrome with an acute neurological impairment due to T11-T12 disc herniation. Material and methods: Clinical and radiological images of the case were retrieved from the medical notes, operative records and imaging system. Results: Posterior surgical correction was proposed to treat the severe spinal deformity; however, surgery was delayed because of SARS-CoV2 pandemic outbreak. During the pandemic, the patient had a major clinical and radiological deterioration with development of paraparesis. Complete clinical resolution of the paraparesis and restoration of balance was achieved with a two stage surgical approach, with a first anterior stage followed by a delayed posterior approach aimed at deformity correction. Discussion: Congenital kyphosis are rare deformities that can progress rapidly leading to severe neurological deficits and worsening of the deformity. When patient has neurological deficit the surgical strategy to address the neurological problem first and plan the more complex and demanding corrective surgery remains a valid strategy that must be consider. Conclusion: This is the first reported case of hyperkyphosis in Mayer-Rokitansky-Küster-Hauser syndrome (MRKH) syndrome surgically treated.

How SARS-CoV-2 Pandemic Changed Traumatology and Hospital Setting: An Analysis of 498 Fractured Patients.

BACKGROUND: SARS-CoV-2 pandemic is one of the biggest challenges for many health systems in the world, making lots of them overwhelmed by the enormous pressure to manage patients. We reported our Institutional Experience, with specific aims to describe the distribution and type of treated injuries, and the organizational setup of our hospital. METHODS: Data of fractured patients admitted for surgical treatment in the time frames 9 March 2020-4 May 2020 and 1 March 2019-31 May 2019 were collected and compared. Furthermore, surgery duration and some parameters of effectiveness in health management were compared. RESULTS: A total of 498 patients were included. Mean age significantly lower age in 2019 and femoral fractures were significantly more frequent 2020. Mean surgery time was significantly longer in 2020. Mortality rate difference between the two years was found to be statistically significant. Time interval between diagnosis and surgery and between diagnosis and discharge/decease was significantly lower in 2020. In 2020, no patient admitted with a negative swab turned positive in any of the following tests for SARS-CoV-2. CONCLUSIONS: The COVID-19 pandemic has modified the epidemiology of hospitalized patients for traumatic reasons, leading to an increased admission of older patients with femoral fractures. Nevertheless, our institutional experience showed that an efficient change in the hospital organization, with an improvement of several parameters of effectiveness in health management, led to a null infection rate between patients.

Mortality and morbidity in COVID-19 orthopedic trauma patients: is early surgery the keystone?

In the pandemic disease caused by SARS-CoV-2 virus, trauma surgery continued the management of patients with fractures. The purpose of the study is to evaluate mortality and morbidity in orthopedic trauma patients surgically treated with a diagnosis of COVID-19 infection, comparing them to a control group of COVID-19 negative. We retrospectively identified patients admitted to our Emergency Room from March 8th to May 4th 2020 (time frame corresponding to the first wave of the pandemic peak, one of the most severe in the world at that time) with a diagnosis of fracture that were subsequently surgically treated. We applied a dedicated pathway for the management of COVID-19 trauma patients allowed to perform an early surgery and short hospitalization. For each patient included demographics, clinical, laboratory, radiological data and type of treatment for COVID-19 infection were collected. Sixty-five (65) patients were identified. Of those, 17 (6 women and 11 men, mean age 63.41 years old, mean ASA grade 2.35) were COVID-19 positive (study group), while the others were control group (mean age 56.58 years old, mean ASA grade 2.21). In the study group, the preoperative laboratory tests showed leukocytosis in six and lymphopenia in 15 cases. Fourteen patients had a high level of C-reactive protein. Fifteen patients had an abnormal level of D-dimer. The mortality recorded was 5.8% and 4.1% in the study and control group respectively. Perioperative adverse events were registered in 5 cases (29.4%) in the study group and in 8 (16.6%) in the control group (p>0.05). Dedicated COVID-19 trauma pathway with the aim of an early surgery could be key for a better result in terms of mortality and morbidity. Age and ASA grade could represent independent risk factors for perioperative complications.

How we managed elective, urgent, and emergency orthopedic surgery during the COVID-19 pandemic: The Milan metropolitan area experience.

The COVID-19 virus is a tremendous burden for the Italian health system. The regionally-based Italian National Health System has been reorganized. Hospitals' biggest challenge was to create new intensive care unit (ICU) beds, as the existing system was insufficient to meet new demand, especially in the most affected areas. Our institution in the Milan metropolitan area of Lombardy, the epicentre of the infection, was selected as one of the three regional hub for major trauma, serving a population of more than three million people. The aims were the increase the ICU beds and the rationalization of human and structural resources available for treating COVID-19 patients. In our hub hospital, the reorganization aimed to reduce the risk of infection and to obtained resources, in terms of beds and healthcare personnel to be use in the COVID-19 emergency. Non-urgent outpatient orthopaedic activity and elective surgery was also suspended. A training programme for healthcare personnel started immediately. Orthopaedic and radiological pathways dedicated to COVID-19 patients, or with possible infection, have been established. In our orthopaedic department, we passed from 70 to 26 beds. Our goal is to treat trauma surgery's patient in the "golden 72 hours" in order to reduce the overall hospital length of stay. We applied an objective priority system to manage the flow of surgical procedures in the emergency room based on clinical outcomes and guidelines. Organizing the present to face the emergency is a challenge, but in the global plan of changes in hospital management one must also think about the near future. We reported the Milan metropolitan area orthopaedic surgery management during the COVID-19 pandemic. Our decisions are not based on scientific evidence; therefore, the decision on how reorganize hospitals will likely remain in the hands of individual countries.