News in paediatric orthopaedic surgery: an overview of the latest advances in paediatric orthopaedics and traumatology (2020-2023).

PURPOSE: We propose to survey - even if arbitrarily - the publications in paediatric orthopaedics and traumatology that have had the greatest impact on the specialty during the period extending from the beginning of the COVID-19 pandemic in December 2020 and the end of all health restrictions in March 2023. METHODS: Only studies with a high level of evidence or clinical relevance were selected. We briefly discussed the results and conclusions of these quality articles to situate them in relation to the existing literature and current practice. RESULTS: Publications are presented by dividing traumatology and orthopaedics whose publications are further subdivided according to anatomical districts; articles concerning neuro-orthopaedics, tumours, and infections were presented separately while sports medicine is jointly presented with knee-related articles. CONCLUSIONS: Despite the difficulties encountered during the global COVID-19 pandemic (2020-2023), orthopaedic and trauma specialists, including paediatric orthopaedic surgeons, have maintained a high level of scientific output, in terms of quantity and quality of production.

The Impact of COVID-19 Redeployment on an Orthopedic Surgery Department at a Tertiary Care Medical Center in New York City.

BACKGROUND: The SARS-CoV-2 (COVID-19) pandemic resulted in new, non-orthopedic roles for many members of our New York City based orthopedic department, including redeployment to medicine wards, emergency departments, and intensive care units. The purpose of this study was to determine if certain areas of redeployment predisposed individuals to higher likelihood of positive diagnostic or serologic testing for COVID-19. METHODS: In this study, attendings, residents, and phy-sician assistants within our orthopedic department were surveyed to determine their roles during the COVID-19 pandemic and whether they were tested via diagnostic or serologic methods for detecting COVID-19. Additionally, symptoms and missed days of work were reported. RESULTS: No significant association between redeployment site and rate of positive COVID-19 diagnostic (p = 0.91) or serologic (p = 0.38) testing was detected. Sixty individuals responded to the survey, with 88.3% of respondents rede-ployed during the pandemic. Nearly half (n = 28) of those redeployed experienced at least one COVID-19 related symptom. Two respondents had a positive diagnostic test, and 10 had a positive serologic test. CONCLUSIONS: Area of redeployment during the COVID-19 pandemic is not associated with an increased risk of subse-quently having a positive diagnostic or serologic COVID-19 test.

The Effects of COVID-19 on Orthopaedic Surgery Training Programs in the United States.

INTRODUCTION: This study investigates the effects of the COVID-19 pandemic on medical education, research opportunities, and mental health in orthopaedic surgical training programs. METHODS: A survey was sent to the 177 Electronic Residency Application Service-participating orthopaedic surgery training programs. The survey contained 26 questions covering demographics, examinations, research, academic activities, work settings, mental health, and educational communication. Participants were asked to assess their difficulty in performing activities relative to COVID-19. RESULTS: One hundred twenty-two responses were used for data analysis. Difficulties were experienced in collaborating with others (49%), learning through online web platforms (49%), maintaining the attention span of others through online web platforms (75%), and in gaining knowledge as a presenter or participating through online web platforms (56%). Eighty percent reported that managing time to study was the same or easier. There was no reported change in difficulty for performing activities in the clinic, emergency department, or operating room. Most respondents reported greater difficulty in socializing with others (74%), participating in social activities with coresidents (82%), and seeing their family (66%). Coronavirus disease 2019 has had a significant effect on the socialization of orthopaedic surgery trainees. DISCUSSION: Clinical exposure and engagement were marginally affected for most respondents, whereas academic and research activities were more greatly affected by the transition from in-person to online web platforms. These conclusions merit investigation of support systems for trainees and evaluating best practices moving forward.

Intimate Partner Violence in the Orthopaedic Patient Population: What Surgeons Need to Know.

¼: Intimate partner violence (IPV) is under-reported and pervasive in the orthopaedic surgical setting. ¼: Screening programs that could increase reporting and assist in treatment and prevention are commonly underutilized. ¼: There is little formalized education during orthopaedic surgery training for IPV. ¼: The incidence of IPV continues to increase in the setting of recent stressors, such as COVID-19, and the orthopaedic surgeon should play a role in the screening and identification of patients presenting with IPV injuries and provide resources and referral.

Intimate Partner Violence in the Orthopaedic Patient Population: What Surgeons Need to Know.

¼: Intimate partner violence (IPV) is under-reported and pervasive in the orthopaedic surgical setting. ¼: Screening programs that could increase reporting and assist in treatment and prevention are commonly underutilized. ¼: There is little formalized education during orthopaedic surgery training for IPV. ¼: The incidence of IPV continues to increase in the setting of recent stressors, such as COVID-19, and the orthopaedic surgeon should play a role in the screening and identification of patients presenting with IPV injuries and provide resources and referral.

Differences in Resumption of Orthopedic Surgery According to Characteristics of Surgery during COVID-19 Pandemic: National Registry Data.

Background: Healthcare services have been restricted after the coronavirus disease 2019 (COVID-19) outbreak. With the pandemic still ongoing, the patterns of orthopedic surgery might have changed. The purpose of this study was to determine whether the reduced volumes of orthopedic surgery were recovered over time. Among the trauma and elective surgery, which accounted for most orthopedic surgical procedures, we also sought to elucidate whether the changes in the volumes of orthopedic surgery differed according to the type of surgery. Methods: The volumes of orthopedic surgery were analyzed using the Health Insurance Review and Assessment Service of Korea databases. The surgical procedure codes were categorized depending on the characteristics of the procedures. The actual volumes of surgery were compared with the expected volumes to elucidate the effect of COVID-19 on surgical volumes. The expected volumes of surgery were estimated using Poisson regression models. Results: The reducing effect of COVID-19 on the volumes of orthopedic surgery weakened as COVID-19 continued. Although the total volumes of orthopedic surgery decreased by 8.5%-10.1% in the first wave, those recovered to a 2.2%-2.8% decrease from the expected volumes during the second and third waves. Among the trauma and elective surgery, open reduction and internal fixation and cruciate ligament reconstruction decreased as COVID-19 continued, while total knee arthroplasty recovered. However, the volumes of hemiarthroplasty of the hip did not decrease through the year. Conclusions: The number of orthopedic surgeries, which had decreased due to COVID-19, tended to recover over time, although the pandemic was still ongoing. However, the degree of resumption differed according to the characteristics of surgery. The findings of our study will be helpful to estimate the burden of orthopedic surgery in the era of persistent COVID-19.

The Impact of COVID-19 Pandemic in Orthopaedic Surgery Hospital Admissions and Workload in a Major Trauma Center.

The coronavirus disease 2019 (COVID-19) pandemic has led to important restrictions in social life of civilians worldwide and there were lower admission rates mainly in surgical departments in many hospitals. This study presents how COVID-19 pandemic affected admissions at the orthopaedic and trauma surgery department of a major trauma center. A retrospective study was conducted that recorded all patients examined at the outpatient orthopaedic clinic and the emergency orthopaedic department, as well as patients admitted to the orthopaedic surgery clinic and patients that underwent operative procedures between March 23 and May 4, 2020 (first lockdown period) and between March 23 and May 4, 2019 (control period). In addition, all patients with hip fractures that required hospitalization and underwent hip surgery were identified during the same time periods. During lockdown period 1 compared with the lock-down period 2 were observed: 70% and 61% decrease in the number of patients examined at the outpatient clinic and the emergency orthopaedic department respectively. The number of patients admitted to the orthopaedic surgery clinic declined by 41%, whereas operative procedures decreased by 22%. Regarding hip fractures timing to surgery during the first period was significantly less compared with second lockdown period, however, hospitalization days remained almost unchanged over the two time lockdown periods. Restrictions during the first lockdown period due to COVID-19 pandemic caused an important decrease in the number of patients and theaters in all orthopaedic departments in one of the major trauma centers in Athens. However, the incidence of hip fractures in elderly was not significantly decreased. Further similar studies are needed to identify variations and patterns of these parameters in other trauma centers.

Impact of COVID-19 on Elective Orthopaedic Surgery Outcomes During the Peak of the Pandemic, an Uptick of Complications: An Analysis of the ACS-NSQIP.

INTRODUCTION: Since the World Health Organization declared a pandemic in March 2020, COVID-19 has pressured the healthcare system. Elective orthopaedic procedures for American seniors were canceled, delayed, or altered because of lockdown restrictions and public health mandates. We sought to identify differences in the complication rates for elective orthopaedic surgeries before and atfter the pandemic onset. We hypothesized that complications increased in the elderly during the pandemic. METHODS: We conducted a retrospective analysis of the American College of Surgeons-National Surgical Quality Improvement Program database in patients older than 65 years undergoing elective orthopaedic procedures from 2019 (prepandemic) and April to December 2020 (during the pandemic). We recorded readmission rates, revision surgery, and 30-day postoperative complications. In addition, we compared the two groups and adjusted for baseline features with standard multivariate regression. RESULTS: We included 146,430 elective orthopaedic procedures in patients older than 65 years (94,289 before the pandemic and 52,141 during). Patients during the pandemic had a 5.787 times greater chance of having delayed wait time to the operating room (P < 0.001), a 1.204 times greater likelihood of readmission (P < 0.001), and a 1.761 times increased chance of delayed hospital stay longer than 5 days (P < 0.001) when compared with prepandemic. In addition, during the pandemic, patients were 1.454 times more likely to experience any complication (P < 0.001) when compared with patients prepandemic undergoing orthopaedic procedures. Similarly, patients were also 1.439 times more likely to have wound complication (P < 0.001), 1.759 times more likely to have any pulmonary complication (P < 0.001), 1.511 times more likely to have any cardiac complication (P < 0.001), and 1.949 times more likely to have any renal complication (P < 0.001). CONCLUSION: During the COVID-19 pandemic, elderly patients faced longer wait times within the hospital and increased odds of complications after elective orthopaedic procedures than similar patients before the pandemic.

Impact of COVID-19 on Elective Orthopaedic Surgery Outcomes During the Peak of the Pandemic, an Uptick of Complications: An Analysis of the ACS-NSQIP.

INTRODUCTION: Since the World Health Organization declared a pandemic in March 2020, COVID-19 has pressured the healthcare system. Elective orthopaedic procedures for American seniors were canceled, delayed, or altered because of lockdown restrictions and public health mandates. We sought to identify differences in the complication rates for elective orthopaedic surgeries before and atfter the pandemic onset. We hypothesized that complications increased in the elderly during the pandemic. METHODS: We conducted a retrospective analysis of the American College of Surgeons-National Surgical Quality Improvement Program database in patients older than 65 years undergoing elective orthopaedic procedures from 2019 (prepandemic) and April to December 2020 (during the pandemic). We recorded readmission rates, revision surgery, and 30-day postoperative complications. In addition, we compared the two groups and adjusted for baseline features with standard multivariate regression. RESULTS: We included 146,430 elective orthopaedic procedures in patients older than 65 years (94,289 before the pandemic and 52,141 during). Patients during the pandemic had a 5.787 times greater chance of having delayed wait time to the operating room (P < 0.001), a 1.204 times greater likelihood of readmission (P < 0.001), and a 1.761 times increased chance of delayed hospital stay longer than 5 days (P < 0.001) when compared with prepandemic. In addition, during the pandemic, patients were 1.454 times more likely to experience any complication (P < 0.001) when compared with patients prepandemic undergoing orthopaedic procedures. Similarly, patients were also 1.439 times more likely to have wound complication (P < 0.001), 1.759 times more likely to have any pulmonary complication (P < 0.001), 1.511 times more likely to have any cardiac complication (P < 0.001), and 1.949 times more likely to have any renal complication (P < 0.001). CONCLUSION: During the COVID-19 pandemic, elderly patients faced longer wait times within the hospital and increased odds of complications after elective orthopaedic procedures than similar patients before the pandemic.

Coaching for the Orthopedic Surgery Leader.

From the increase in telehealth to the expansion of private investors to the growth of transparency (both price and patient outcomes) and value-based care initiatives, health-care delivery is rapidly changing. At the same time, demand for musculoskeletal care continues to rapidly increase, with more than 1.7 billion people globally suffering from musculoskeletal conditions, yet burnout is a major concern and growing since the onset COVID-19 global pandemic. When taken together, these factors have a major impact on the health-care delivery environment and pose enormous challenges and increased stressors on orthopedic surgeons and their teams. Coaching can help.

The Impact of COVID-19 on Surgical Volume and Productivity at an Academic Orthopaedic Surgery Department.

COVID-19 pandemic rapidly progressed, resulting in temporary cessation of elective surgery in the U.S. The goal of this study was to evaluate the impact of COVID-19 on surgical volume, charges, work relative value units (WRVUs), and net receipts at an academic orthopaedic surgery department. Volume of cases per month decreased from 745 cases in February to 173 cases in April, with a 75% decrease in charges and a 73% decrease in WRVUs. The largest decreases in productivity were in Sports (92% decrease in charges and WRVUs), Pediatrics (88% decrease in charges, 87% decrease in WRVUs), and Joints (81% decrease in charges, 78% decrease in WRVUs). Oncology was least impacted (27% decrease in charges, 20% decrease in WRVUs). Recovery after shutdown was rapid, with charges and WRVUs returning to pre-COVID levels by June. Productivity of the Sports, Pediatrics and Joints were most impacted, while Oncology, Hand, and Trauma were least impacted. (Journal of Surgical Orthopaedic Advances 31(4):226-229, 2022).

A systematic review of cost and well-being in hip and knee replacements surgical site infections.

This systematic review examined peer-reviewed literature published from 2010 to 2020 to investigate the health care system costs, hidden out-of-pocket expenses and quality of life impact of surgical site infections (SSIs) and to develop an overall summary of the burden they place on patients. SSI can significantly impact patients' treatment experience and quality of life. Understanding patients' SSI-related burden may assist in developing more effective strategies aimed at lessening the effects of SSI in financial and well-being consequences. Peer-reviewed articles on adult populations (over 18 years old) in orthopaedic elective hip and knee surgeries published from 2010 to 2020 were considered. Only publications in English and studies conducted in high-income countries were eligible for inclusion. A search strategy based on the MESH term and the CINAHL terms classification was developed. Five databases (Scopus, EMBASE, CINAHL, Medline, Web of Science) were searched for relevant sources. Reviewers categorised and uploaded identified citations to Covidence and EndNoteX9. Reviewers will assess article titles, abstracts and the full text for compliance with the inclusion criteria. Ongoing discussions between reviewers resolved disagreements at each selection process stage. The final scoping review reported the citation inclusion process and presented search results in a PRISMA flow diagram. Four main themes were extracted from a thematic analysis of included studies (N = 30): Hospital costing (n = 21); Societal perspective of health system costing (n = 2); Patients and societal well-being (n = 6) and Epidemiological database and surveillance (n = 22). This systematic review has synthesised a range of themes associated with the overall incidence and impact of SSI that can inform decision making for policymakers. Further analysis is required to understand the burden on SSI patients.

OrthoACCESS: Implementing a Sub-Internship Curriculum for MS4s Applying to Orthopaedic Surgery.

OBJECTIVE: Medical students pursuing orthopedic surgery residency build foundational knowledge during clinical rotations. Most clinical rotations, home and away, were paused during the COVID-19 pandemic. Given the lack of structured fourth-year medical student (MS4) education for basic orthopedics, educators developed the Ortho Acting-Intern Coordinated Clinical Education and Surgical Skills (OrthoACCESS) curriculum in 2019. This study demonstrates the accessibility and usability of a MS4 virtual orthopedic curriculum and examines the curriculum's role in increasing learner familiarity with basic orthopedic topics in 2020. DESIGN: OrthoACCESS faculty presented weekly lectures from July to October 2020 using Zoom Webinar. Website content included recorded webinars, external resources, and skills videos. Registrants were anonymously surveyed after each webinar characterizing the knowledge and utility of individual lectures. After the webinar series, registrants were emailed an anonymous post-curriculum survey characterizing their experience using the OrthoACCESS curriculum. RESULTS: OrthoACCESS had 1062 registrants, with 59% (624/1,062) MS4s. 4528 users accessed the OrthoACCESS website from 66 countries. The 15 lectures were viewed 3743 times, 1553 live views and 2190 asynchronous views. 444 postwebinar surveys were completed. Weekly response rates ranged from 18% to 45%. Respondents felt more knowledgeable and more able to apply their knowledge after viewing each lecture (p < 0.001), and found the webinars to be well-organized, well-paced, enthusiastically taught, and level-appropriate. 122/976 (13%) students and 45/291 (15%) faculty completed the postcurriculum survey. Faculty reported that OrthoACCESS was "quite useful" (4 [3-5]) for providing knowledge for an incoming orthopaedic intern. Faculty and students would recommend OrthoACCESS to future learners (5 [4-5]). CONCLUSIONS: OrthoACCESS delivered foundational musculoskeletal instruction during a period of increased need. In its initial iteration, this virtual curriculum demonstrated high utilization in the United States and internationally and improved participants' self-reported topical knowledge and ability to apply it clinically.

[Impact of the COVID-19 crisis in Spring 2020 on trauma case numbers of an academic teaching hospital in Stuttgart : Trauma during a pandemic]. / Einfluss der COVID-19-Krise im Frühjahr 2020 auf traumatologische Fallzahlen eines akademischen Lehrkrankenhauses in Stuttgart : Trauma während einer Pandemie.

BACKGROUND: To cope with the COVID-19 outbreak in Germany, the government imposed a lockdown, which led to restrictions and lifestyle changes for the population. PURPOSE: This study aimed to evaluate the impact of the lockdown on activities causing trauma and the consultation in emergency rooms. MATERIAL AND METHODS: All consecutive trauma patients consulting the Emergency Department of the Marienhospital Stuttgart (MHS), Germany, during the 6 weeks preceding the lockdown, during and after the lockdown were included. The time and type of consultation, treatment received, Manchester triage score, type of trauma, the anatomical region of the injury as well as demographic data were reported and compared. RESULTS: The study included 551 cases during lockdown, 943 cases before and 783 cases after the lockdown. We observed a reduced caseload during the lockdown of 41.6% compared to before and of 29.7% compared to after (p < 0.001). Patients were on average older in the observation group than in both control groups (before : 51.5 years, lockdown: 56.1 years, after: 51.6 years) (p < 0.001). Injuries to the head and neck were constant (25.0%, 25.4%, 25.5%). We noticed lower limb injuries decreasing (26.1%, 22.3%, 22.7%) and upper limb injuries increasing (25.5%, 31.8%, 30.1%). A decrease in sports injuries (11.1%, 5.1%, 9.1%) and work accidents (16.1%, 10.7%, 12.8%) resulted in more domestic accidents (30.4%, 52.5%, 31.8%). Self-referral decreased (67.7%, 53.2%, 60.3%) while referral via paramedics increased (28.3%, 38.7%, 35.6). Blunt trauma was the most common cause of injury (55.6%, 61.0%, 55.3%). Indications for surgery were higher (16.8%, 21.6%, 14.0%). CONCLUSION: The lockdown and restrictions in personal life and daily routine had an impact on the frequency, etiology and management of trauma patients in Stuttgart.