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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
Plast Reconstr Surg ; 146(2): 248e-250e, 2020 08.
Article in English | MEDLINE | ID: covidwho-703566
J Orthop Trauma ; 34(10): e371-e376, 2020 10.
Article in English | MEDLINE | ID: covidwho-641635


OBJECTIVES: To describe clinical characteristics of fracture patients, including a closer look to hip fracture patients, and determine how epidemiological variables may have influenced on a higher vulnerability to SARS-CoV-2 infection, as the basis for the considerations needed to reintroduce elective surgery during the pandemic. DESIGN: Longitudinal prospective cohort study. SETTING: Level I Trauma Center in the East of Spain. PATIENTS/PARTICIPANTS: One hundred forty-four consecutive fracture patients 18 years or older admitted for surgery. INTERVENTION: Patients were tested for SARS-CoV-2 with either molecular and/or serological techniques and screened for presentation of COVID-19. MAIN OUTCOME MEASUREMENTS: Patients were interviewed and charts reviewed for demographic, epidemiological, clinical, and surgical characteristics. RESULTS: We interviewed all patients and tested 137 (95.7%) of them. Three positive patients for SARS-CoV-2 were identified (2.1%). One was asymptomatic and the other 2 required admission due to COVID-19-related symptoms. Mortality for the whole cohort was 13 patients (9%). Significant association was found between infection by SARS-CoV-2 and epidemiological variables including: intimate exposure to respiratory symptomatic patients (P = 0.025) and intimate exposure to SARS-CoV-2-positive patients (P = 0.013). No association was found when crowding above 50 people was tested individually (P = 0.187). When comparing the 2020 and 2019 hip fracture cohorts we found them to be similar, including 30-day mortality. A significant increase in surgical delay from 1.5 to 1.8 days was observed on the 2020 patients (P = 0.034). CONCLUSIONS: Patients may be treated safely at hospitals if strict recommendations are followed. Both cohorts of hip fracture patients had similar 30-day mortality. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Betacoronavirus , Coronavirus Infections/complications , Fracture Fixation/standards , Hip Fractures/complications , Hip Fractures/epidemiology , Hospitals/standards , Patient Safety , Pneumonia, Viral/complications , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19 , Coronavirus Infections/epidemiology , Female , Follow-Up Studies , Hip Fractures/surgery , Humans , Male , Middle Aged , Pandemics , Pneumonia, Viral/epidemiology , Prevalence , Prospective Studies , Risk Factors , SARS-CoV-2 , Spain/epidemiology , Survival Rate/trends , Treatment Outcome , Young Adult
J Bone Joint Surg Am ; 102(13): 1116-1122, 2020 Jul 01.
Article in English | MEDLINE | ID: covidwho-594091


The SARS-CoV-2 (severe acute respiratory syndrome-coronavirus 2) was reported in Wuhan, Hubei Province, People's Republic of China, and, subsequently, in other provinces and regions across the People's Republic of China and >212 countries. COVID-19, the disease caused by this coronavirus, was declared a worldwide pandemic by the World Health Organization (WHO). The incidence of patients with fracture who are also positive for COVID-19 is on the rise. The diagnosis and management of such patients can be complicated as their clinical characteristics are heterogeneous. Furthermore, a surgical procedure can be particularly challenging given that the use of high-speed devices results in aerosol generation. In this study, we develop and propose globally applicable guidelines to fill this knowledge gap and we identify and propose the necessary protective strategies for medical personnel in an orthopaedic emergency department and in the inpatient wards. We also introduce diagnostic criteria, surgical complication management, and follow-up strategies for infected patients. These guidelines may be helpful to decrease the infection rate of orthopaedic trauma personnel and to provide diagnosis and treatment therapy for patients with fracture and COVID-19.

Coronavirus Infections/diagnosis , Fracture Fixation/standards , Fractures, Bone/diagnosis , Fractures, Bone/surgery , Pandemics , Pneumonia, Viral/diagnosis , Betacoronavirus , COVID-19 , Coronavirus Infections/complications , Emergencies , Fractures, Bone/complications , Humans , Perioperative Care , Pneumonia, Viral/complications , Practice Guidelines as Topic , SARS-CoV-2