RESUMEN
OBJECTIVE: To determine if reamed intramedullary nailing (IMN) of tibial and femoral shaft fractures exacerbated the hypercoagulable state of COVID infection, resulting in increased thromboembolic and pulmonary complications. DESIGN: Retrospective chart review. SETTING: Eleven Level I trauma centers. PATIENTS: From January 1, 2020, to December 1, 2022, 163 patients with orthopaedic trauma and COVID positivity and 36 patients with tibial and femoral shaft fractures were included. INTERVENTION: Reamed IMN. MAIN OUTCOME MEASURES: Incidence of postoperative thromboembolic and respiratory complications. RESULTS: Thirty-six patients with a median age of 52 years (range, 18-92 years; interquartile range, 29-72 years) met criteria. There were 21 and 15 patients with femoral and tibial shaft fractures. There were 15 patients sustaining polytrauma; of which, 10 had a new injury severity score of >17. All patients underwent reamed IMN in a median of 1 day (range, 0-12 days; interquartile range = 1-2 days) after injury. Two patients developed acute respiratory distress syndrome (ARDS) and 3 pneumonia. No patients had pulmonary embolism, deep vein thrombosis, or died within 30 days. CONCLUSION: In this multi-institutional review of COVID-positive patients undergoing reamed IMN, there were no thromboembolic events. All patients developing pulmonary complications (ARDS or pneumonia) had baseline chronic obstructive pulmonary disease, were immune compromised, or sustained polytraumatic injuries with new injury severity score of >20. Given this, it seems reasonable to continue using reamed IMN for tibial and femoral shaft fractures after evaluation for COVID severity, comorbidities, and other injuries. LEVELS OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Asunto(s)
COVID-19 , Fracturas del Fémur , Fijación Intramedular de Fracturas , Síndrome de Dificultad Respiratoria , Fracturas de la Tibia , Humanos , Adolescente , Adulto Joven , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Fijación Intramedular de Fracturas/efectos adversos , Fijación Intramedular de Fracturas/métodos , Estudios Retrospectivos , COVID-19/epidemiología , Fracturas del Fémur/cirugía , Fracturas del Fémur/etiología , Fracturas de la Tibia/complicaciones , Fracturas de la Tibia/cirugía , Extremidad InferiorRESUMEN
Rare intraocular complication in a healthy immunocompetent patient with an atypical organism following presumed haematogenous spread after a highly contaminated open tibial fracture.
Asunto(s)
Endoftalmitis , Fracturas Abiertas , Fracturas de la Tibia , Endoftalmitis/etiología , Enterococcus , Fracturas Abiertas/diagnóstico por imagen , Fracturas Abiertas/cirugía , Humanos , Fracturas de la Tibia/complicaciones , Fracturas de la Tibia/diagnóstico por imagenRESUMEN
The novel coronavirus, named SARS-CoV-2, responsible of the COVID-19 is now causing a pandemic. Detecting all possible cases and eliminating differential diagnoses in front of any acute respiratory distress has become a daily challenge for doctors around the world. We believe that non-COVID patients are the hidden victims of the actual health problematic. We report from this manuscript the case of a patient with fat embolism syndrome that has been suspected as COVID-19.