The risk of COVID-19 transmission upon return to sport: a systematic review.

OBJECTIVES: To evaluate COVID-19 transmission rates in athletes upon return to sport (RTS), as well as the effectiveness of preventive and surveillance measures associated with RTS. METHODS: In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the PubMed, Embase, and Cochrane Library databases were searched to identify all articles reporting on RTS during COVID-19. Articles were excluded on the basis of the following criteria: (1) non-English text, (2) only abstract available, (3) population not athlete-specific, (4) outcome not RTS-specific, (5) COVID-19 transmission data not quantified, (6) editorial, or (7) review article or meta-analysis. Study characteristics; athlete demographics; COVID-19 preventive, surveillance, and diagnostic measures; COVID-19 transmission outcomes; and RTS recommendations were collected from each included article and analyzed. RESULTS: 10 studies were included in the final analysis, comprising over 97,000 athletes across a wide variety of sports, levels of play, and RTS settings. Of the 10 studies, eight identified low transmission rates and considered RTS to be safe/low risk. Overall, COVID-19 transmission rates were higher in athletes than in contacts, and more prevalent in the greater community than in athletes specifically. The risk of COVID-19 did not appear to be necessarily higher for athletes who played high-contact team sports, shared common facilities, or lived in communities impacted by high transmission rates, provided that rigorous COVID-19 safety and testing protocols were implemented and followed. Mask wearing and physical distancing during active play presented the greatest challenge to athletes. CONCLUSION: Rigorous preventive and surveillance measures can mitigate the risk of COVID-19 transmission in athletes upon RTS. However, the heterogeneity of RTS playing conditions, availability of COVID-19 resources, rise of unforeseen novel variants, and undetermined long-term impact of vaccination on athletes remain a challenge to safe and effective RTS in the era of COVID-19.

Telehealth Utilization in Response to the COVID-19 Pandemic in Pediatric Orthopaedic Surgery.

INTRODUCTION: The purpose of this investigation was to assess the utilization of telehealth capabilities by pediatric orthopaedic departments across the United States in response to the COVID-19 pandemic. METHODS: One hundred four pediatric orthopaedic departments were investigated regarding each institution's current telehealth utilization as a direct response to the COVID-19 pandemic. RESULTS: Of the 104 hospitals contacted across the United States, 100 pediatric orthopaedic departments in 39 states responded for an overall response rate of 96%. Of the 95 institutions offering telehealth services, 83 (87.4%) cited the COVID-19 pandemic as the impetus for the implementation of telehealth services. Of these, 29 institutions (31%) began offering services from March 16 to March 31 and 34 (36%) began offering services from April 1 to April 15. Regional analysis demonstrated an 800% increase in telehealth services in the state of New York, a 600% increase in Florida, a 500% increase in Texas, a 400% increase in Michigan, a 200% increase in Pennsylvania, and a 1,100% increase in California. DISCUSSION: This study demonstrates the rapid response measures instituted by pediatric orthopaedic institutions to meet the fundamental needs of the pediatric population during this unprecedented pandemic.

Timing and Tips for Total Hip Arthroplasty in a Critically Ill Patient With Coronavirus Disease 2019 and a Femoral Neck Fracture.

Expedited time to surgery after hip fracture is associated with decreased morbidity and mortality in appropriately optimized patients. However, the optimal timing of surgery in patients with the novel coronavirus disease 2019 (COVID-19) infection remains unknown. This case report describes a patient with COVID-19 pneumonia complicated by multiorgan system failure requiring intubation who sustained a femoral neck fracture that required total hip arthroplasty. This patient had a significant, deliberate delay in time to surgical intervention because of his critical state. When deciding the optimal timing for total hip arthroplasty in patients with COVID-19, we recommend using inflammatory markers, such as procalcitonin and interleukin-6, as indicators of disease resolution and caution operative intervention when patients are nearing the 7-10th day of COVID-19 symptoms. Furthermore, implant cementation and spinal anesthesia in critically ill COVID-positive patients should be approached cautiously in the setting of pulmonary disease and multiorgan system failure. Close follow-up with medical doctors is recommended to minimize long-term sequelae and delay to baseline mobility.

Telehealth Utilization in Response to the Novel Coronavirus (COVID-19) Pandemic in Orthopaedic Surgery.

INTRODUCTION: The purpose of this investigation is to assess the current utilization of telehealth capabilities at academic orthopaedic departments in the United States and to determine how practice patterns have been directly influenced by the coronavirus disease 19 (COVID-19) pandemic. METHODS: Orthopaedic surgery programs participating in the Electronic Residency Application Service were identified. One hundred seventy-five (175) programs were presented with a seven-item questionnaire addressing whether each program is using telehealth services in response to the COVID-19 pandemic. RESULTS: Of the 175 Electronic Residency Application Service participant orthopaedic programs, 168 responded for a total response rate of 96%. Of the 106 institutions using telehealth services, 88 (83%) cited the COVID-19 pandemic as the impetus for implementation of telehealth services. Institutions located in the Northeast and South regions were markedly more likely to offer telehealth services. Heat map analysis demonstrates an associative overlap of regional "hot spots" with direct comparison of COVID-19 cases in the United States and orthopaedic departments providing telehealth services. DISCUSSION: This study demonstrates the impressive measures academic orthopaedic institutions are taking to meet the needs of our patients by identifying a notable increase in new telehealth offerings throughout the United States with a positive correlation with COVID-19 disease burden.