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J Bone Joint Surg Am ; 102(13): e66, 2020 Jul 01.
Article in English | MEDLINE | ID: covidwho-981469


BACKGROUND: Closed reduction and percutaneous pinning (CRPP) of supracondylar humeral fractures is one of the most common procedures performed in pediatric orthopaedics. The use of full, standard preparation and draping with standard personal protective equipment (PPE) may not be necessary during this procedure. This is of particular interest in the current climate as we face unprecedented PPE shortages due to the current COVID-19 pandemic. METHODS: This is a retrospective chart review of 1,270 patients treated with CRPP of a supracondylar humeral fracture at 2 metropolitan pediatric centers by 10 fellowship-trained pediatric orthopaedic surgeons. One surgeon in the group did not wear a mask when performing CRPP of supracondylar humeral fractures, and multiple surgeons in the group utilized a semisterile preparation technique (no sterile gown or drapes). Infectious outcomes were compared between 2 groups: full sterile preparation and semisterile preparation. We additionally analyzed a subgroup of patients who had semisterile preparation without surgeon mask use. Hospital cost data were used to estimate annual cost savings with the adoption of the semisterile technique. RESULTS: In this study, 1,270 patients who underwent CRPP of a supracondylar humeral fracture and met inclusion criteria were identified. There were 3 deep infections (0.24%). These infections all occurred in the group using full sterile preparation and surgical masks. No clinically relevant pin-track infections were noted. There were no known surgeon occupational exposures to bodily fluid. It is estimated that national adoption of this technique in the United States could save between 18,612 and 22,162 gowns and masks with costs savings of $3.7 million to $4.4 million annually. CONCLUSIONS: We currently face critical shortages of PPE due to the COVID-19 pandemic. Data from this large series suggest that a semisterile technique during CRPP of supracondylar humeral fractures is a safe practice. We anticipate that this could preserve approximately 20,000 gowns and masks in the United States over the next year. Physicians are encouraged to reevaluate their daily practice to identify safe opportunities for resource preservation. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Coronavirus Infections , Fracture Fixation/standards , Health Care Rationing/organization & administration , Humeral Fractures/surgery , Pandemics , Personal Protective Equipment/supply & distribution , Pneumonia, Viral , Surgical Wound Infection/prevention & control , Betacoronavirus , Bone Nails , COVID-19 , Child , Child, Preschool , Closed Fracture Reduction/adverse effects , Closed Fracture Reduction/standards , Female , Fracture Fixation/adverse effects , Health Care Rationing/economics , Health Care Rationing/methods , Humans , Infection Control/economics , Infection Control/standards , Male , Personal Protective Equipment/economics , Retrospective Studies , SARS-CoV-2 , Surgical Wound Infection/etiology , United States/epidemiology
Acta Orthop ; 91(6): 639-643, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-748293


Background and purpose - Following the outbreak of COVID-19 in December 2019, in China, many hip fracture patients were unable to gain timely admission and surgery. We assessed whether delayed surgery improves hip joint function and reduces major complications better than nonoperative therapy. Patients and methods - In this retrospective observational study, we collected data from 24 different hospitals from January 1, 2020, to July 20, 2020. 145 patients with hip fractures aged 65 years or older were eligible. Clinical data was extracted from electronic medical records. The primary outcomes were visual analogue scale (VAS) score and Harris Hip Score. Major complications, including deep venous thrombosis (DVT) and pneumonia within 1 month and 3 months, were collected for further analysis. Results - Of the 145 hip fracture patients 108 (median age 72; 70 females) received delayed surgery and 37 (median age 74; 20 females) received nonoperative therapy. The median time from hip fracture injury to surgery was 33 days (IQR 24-48) in the delayed surgery group. Hypertension, in about half of the patients in both groups, and cerebral infarction, in around a quarter of patients in both groups, were the most common comorbidities. Both VAS score and Harris Hip Score were superior in the delayed surgery group. At the 3-month follow-up, the median VAS score was 1 in the delayed surgery group and 2.5 in the nonoperative group (p < 0.001). Also, the percentage of complications was higher in the nonoperative group (p = 0.004 for DVT, p < 0.001 for pulmonary infection). Interpretation - In hip fracture patients, delayed surgery compared with nonoperative therapy significantly improved hip function and reduced various major complications.

Cerebral Infarction , Conservative Treatment , Fracture Fixation , Hip Fractures , Hypertension , Postoperative Complications , Time-to-Treatment/statistics & numerical data , Aged , COVID-19/epidemiology , COVID-19/prevention & control , Cerebral Infarction/epidemiology , Cerebral Infarction/etiology , Cerebral Infarction/prevention & control , China/epidemiology , Conservative Treatment/adverse effects , Conservative Treatment/methods , Conservative Treatment/statistics & numerical data , Electronic Health Records/statistics & numerical data , Female , Fracture Fixation/adverse effects , Fracture Fixation/methods , Fracture Fixation/statistics & numerical data , Hip Fractures/epidemiology , Hip Fractures/therapy , Humans , Hypertension/epidemiology , Hypertension/etiology , Hypertension/prevention & control , Male , Outcome and Process Assessment, Health Care , Postoperative Complications/epidemiology , Postoperative Complications/prevention & control , SARS-CoV-2