ABSTRACT
In the current time of coronavirus disease-2019 (COVID-19) pandemic, orthopedic procedures have been shelved and guidelines to establish the safety of medical professionals and patients are still evolving. Although sports injuries are not life threatening, a spectrum of these injuries requires urgent intervention. To ensure the safety of medical professionals and patients of sports injuries in COVID times, the following guidelines are suggested. Such surgery needs to be performed only in COVID-free facility (green zone). Patients from red zone and containment zone should be avoided. Young, fit individuals without medical comorbidities should be considered. Wherever possible, regional anesthesia should be used. As COVID virus is present in all body fluids, aerosol generation (coughing, sneezing, intubation, use of power instruments, and cautery) should be minimized. Operation theater (OT) should be fumigated on the prior night and ideally between the cases. The number of cases per OT should be kept under three to get adequate time in-between for sterilization. The ventilation setup of OT should be negative pressure in addition to positive pressure. If there are hindrances in setting up negative pressure, a simple exhaust can be added to the existing setup. The ventilation system should ideally provide more than 20 air changes per hour. During surgery, movement of doors of OT and OT personnel should be minimal so as to minimize the air turbulence and eddy current. This will reduce the risk of infection. Surgical team should wear personal protective equipment (PPE) and helmet hood to reduce the chances of respiratory droplet infection. The doffing of helmet and PPE should be done with utmost care and should be discarded in a chloro-derivate solution. The motorized drill used for surgical procedure should be used at low revolution per minute (RPM). Usage of sterile transparent polythene hood while irrigating during drilling and sequential drilling will help in minimizing aerosol generation. Spillage of arthroscopic fluid should be avoided at all times. These basic norms will minimize the chance of accidental spread of COVID.
ABSTRACT
Introduction: Tele-rehabilitation is a method of delivering rehabilitation services using information, technology and communication to everyone, irrespective of their geographic location. National zeal for competitive sports and COVID pandemic has led to an increase in its demand and popularity worldwide. The athletes need immediate treatment and correct rehabilitation to keep them in their game. This review aims to bring into perspective the importance of telemedicine and telerehabilitation in orthopaedics and sports medicine with a focus on virtual reality. Methods: Articles were searched based on suitable keywords 'telemedicine', 'telerehabilitation' 'orthopedics', 'orthopaedics', 'sports' and 'India*' which were combined using suitable boolean operators in PubMed, Scopus and Web of Science. Government guidelines and laws were also reviewed in view of telehealth and telemedicine. Conclusion: Tele-rehabilitation and virtual physical therapy are innovative and cost-effective ways to provide the best rehabilitative services to the patients at their doorstep. Virtual reality should be incorporated into the Indian telehealth delivering system with a special focus on the remote athlete population.
ABSTRACT
PURPOSE: The COVID-19 pandemic has affected orthopedic practices worldwide. Few studies focusing on epidemiology and management of fractures in COVID-19 patients have been published. We conducted a systematic review to evaluate the fracture types, presentation, treatment, complications, and early outcomes of fractures occurring amidst COVID-19 pandemic. METHODS: A systematic review of the all published papers was conducted with a comprehensive search of PubMed, Google Scholar, Scopus, and Cochrane Library database using keywords 'COVID-19', 'Coronavirus', 'trauma∗'and 'fracture' from January-April 2020. RESULTS: The searches yielded a total of ten studies with 112 Patients who were positive for COVID-19 associated with fractures was performed for six studies, reporting data separately for 44 patients with COVID 19 and an associated fracture. A diagnosis of COVID 19 was made on the basis of positive Computed Tomography scan in 39 patients and 30 patients had a positive Reverse Transcription-Polymerase Chain Reaction test. Overall, there were 29 proximal femoral fractures, 8 spine fractures, 7 fractures of the other bones. The fractures were treated surgically in 30 cases (68.18%) and the remaining 14 cases (31.82%) were managed conservatively. There were 16 patients (36.36%) who died, mostly due to respiratory failure with a median age of 82 years. CONCLUSION: COVID-19 has led to a significant reduction in a load of fracture patients globally, though the incidence of fragility fractures continues to be unaffected. There is a significantly higher risk of mortality in elderly patients with fractures and hence they should only be operated in a facility with a robust intensive care. Conservative treatment should be adopted as far as possible in non-obligatory fractures and in lesser equipped centers. Surgery in patients with proximal femur fragility fractures when judiciously selected did result in improvement in respiratory status. Reorganizing medical services is vital to deliver effective fracture care and also mitigate disease transmission.
ABSTRACT
The Coronavirus SARS-CoV-2 (COVID-19) pandemic has had a substantial effect on the health care systems around the world. As the disease has spread, many developed and developing countries have been stretched on their resources such as personnel as well as adequate equipment. As a result of resource disparity, in a populous country like India, the elective orthopaedic surgeries stand cancelled whilst trauma and emergency services have been reorganised following Indian Orthopaedic Association and recent urgent British Orthopaedic association guidelines. Though these guidelines provide strategies to deal with trauma and orthopaedic surgery management in the present scenario, once the COVID-19 pandemic stabilizes, restarting elective orthopaedic surgery and managing delayed trauma conditions in evolving health care systems is going to be a profound task. We look at the future challenges and considerations of re-establishing trauma and orthopaedic flow during the post-COVID-19 phase and suggest an algorithm to follow (Fig. 1).
ABSTRACT
Severe Acute Respiratory Syndrome COVID-19 was declared as a pandemic on 11th March 2020 by the World Health Organization and consequent lockdown imposed in several areas resulted in a marked reduction in orthopaedic practice. Although some guidelines for patient care in orthopaedic practice have been published, overall, publications focusing exclusively on guidelines on starting orthopaedic outpatient departments (OPD) after the COVID-19 lockdown amidst the on-going pandemic are lacking. We hereby propose the evolving knowledge in changes in OPD management practices for orthopaedic surgeons in the COVID- 19 era. The emphasis on online registration (e-registration) should be given impetus and become the new norm supplemented by telephonic and spot registration for the uneducated patients. The review highlights the safety of patient and orthopaedic surgeons in OPD by screening and maintaining hygiene at various levels. The article also mentions the duties of the help desk, OPD hall supervisor and the new norms of Air Conditioning, ventilation, safe use of elevators, sanitization of OPD premises and biomedical waste disposal. The optimum and safe utilization of human & material resources, DO's and DON'Ts for patients & health staff have also been proposed. The reorganization of plaster room, the precaution during plastering, fracture clinic, dressing and injection room services are discussed as per evolving guidelines. This article will give deep insight into the OPD plan &telemedicine graphically also. The authors suggest updating and downward permeation of existing e-infrastructure of government health services that is up-gradation of existing tertiary level online registration services, a paperless model of OPD Consultation & dispensation. The future updating of Aarogya Setu App (https://mygov.in/aarogya-setu-app/). for convenient online OPD registration and dispensation has been discussed and proposed. This review will help in containing the spread of COVID 19 and build upon the health gains achieved after lockdown. The easy concept of CCCATTT has been introduced, and the OPD Plan has also been suggested. We have endeavoured to holistically detail an orthopaedic OPD setup and its upkeep in COVID-19 pandemic, but since the knowledge of COVID 19 is ever-evolving it needs replenishment by regular education for health staff.