Effectiveness of Needle Tenotomy for Correction of Equinus in Clubfoot.

INTRODUCTION: During the COVID-19 surge, due to a lack of operating room availability, we performed Achilles tendon tenotomy in clubfoot patients using a 16/18 gauge needle to avoid delay in their management. The procedures were performed on an outpatient basis. The current retrospective study aims to investigate the effectiveness of needle tenotomy for the correction of equinus in clubfoot at a minimum of one year of follow-up. METHODS: Clinical records of all clubfoot patients that underwent needle tenotomy of Achilles tendon from March 2020 onwards with at least one year of follow-up were reviewed. We recorded Pirani scores and the equinus deformity at the initial presentation, after Achilles tendon tenotomy, and at the final follow-up. We also recorded any procedure-related complications following the Achilles tendon tenotomy. We compared dorsiflexion after final cast removal and after one year of follow-up. RESULTS: A total of 26 clubfeet in 14 patients underwent needle tenotomy of the Achilles tendon and completed one year of follow-up. Ankle dorsiflexion was achievable in all patients and the mean dorsiflexion of 27.4 degrees. The average Pirani score after tenotomy at final cast removal was 0.16, while the mean dorsiflexion at final cast removal was 24.2 degrees (p = .00084). No tenotomy procedure-related complications were noted. CONCLUSION: Percutaneous needle tenotomy of the Achilles tendon is a simple, safe, and effective technique for equinus correction in clubfoot. Considering the less invasive nature of the procedure, it can be done as a short procedure on an outpatient basis and has a limited risk of hemorrhage and other wound-related complications.

Patient Preferences Regarding Telemedicine to In-person Consultation: A Questionnaire-Based Survey.

Introduction: Telemedicine has been evolving over the last two decades; however, with the advent of the COVID 19 pandemic, its utility and acceptance have drastically increased. Most studies report increasing acceptability and satisfaction rates. This study aimed to assess patient preferences regarding telemedicine to in-person consultations and to attempt to assess the factors driving these preferences. Material and Methods: A questionnaire-based cross-sectional study was conducted for patients who had both teleconsultation and in-person consultation in the orthopedic outpatient. After obtaining consent to participate in the study, the patients were divided into broad clinical categories and responses were recorded regarding the treatment of illness by the doctor and opinions regarding telemedicine. Most questions were in yes/no or a Likert-based questionnaire. Mean, median, percentage and proportions were used for statistical analysis of the data. Results: The study group included 264 patients, with the majority with fractures and dislocations. Most patients (55.7%) were comfortable using the software for teleconsultation, and half the respondents found telemedicine convenient. A large percentage of the study group preferred in-person consultation to teleconsultation (58.7%), and the primary reasons for discontinuing teleconsultation were dissatisfaction during the interaction with the doctor and poor connectivity to telecommunication networks. Conclusion: Telecommunication has high acceptance and satisfaction, but many factors limit its acceptance in developing countries.

Telemedicine trends in orthopaedics and trauma during the COVID-19 pandemic: A bibliometric analysis and review.

OBJECTIVES: In the wake of recent widespread interest in telemedicine during the COVID-19 era, many orthopaedic surgeons may be unfamiliar with clinical examination skills, patients' safety, data security, and implementation-related concerns in telemedicine. We present a bibliometric analysis and review of the telemedicine-related publications concerning orthopaedics care during the COVID-19 pandemic. Such analysis can help orthopaedic surgeons become acquainted with the recent developments in telemedicine and its usage in regular orthopaedics practice. METHODS: We systematically searched the database of Thomson Reuters Web of Science for telemedicine-related articles in orthopaedics published during the COVID-19 pandemic. The selected articles were analysed for their source journals, corresponding authors, investigating institutions, countries of the corresponding authors, number of citations, study types, levels of evidence, and a qualitative review. RESULTS: Fifty-nine articles meeting the inclusion criteria were published in 28 journals. Three hundred forty-two authors contributed to these research papers. The United States (US) contributed the most number of articles to the telemedicine-related orthopaedics research during the COVID-19 era. All articles combined had a total of 383 citations and 66.1% were related to the Economic and Decision-making Analyses of telemedicine implementation. By and large, level IV evidence was predominant in our review. CONCLUSION: Telemedicine can satisfactorily cover a major proportion of patients' visits to outpatient departments, thus limiting hospitals' physical workload. Telemedicine has a potential future role in emergency orthopaedics and inpatient care through virtual aids. The issues related to patient privacy, data security, medicolegal, and reimbursement-related aspects need to be addressed through precise national or regional guidelines. Lastly, the orthopaedic physical examination is a weak link in telemedicine and needs to be strengthened.

Comparison of three low-cost techniques to control fogging of sealed eyewear in a simulated operating room environment: A preliminary analysis.

PURPOSE: In the current COVID pandemic, hermetically sealed eyewear is recommended for safe surgical practices to prevent eye contact with contaminated airborne particles or aerosols. These sealed eyewears definitely reduce the risk of contamination of eyes. However, there is a constant issue of fogging up of the inner surface that prevents good surgical visibility which can impair surgeons' performance and their ability to perform fine tasks, especially in operating rooms with temperature and humidity controlled as per the COVID guidelines. We investigated the effectiveness of surface-modified anti-fog polyethylene terephthalate(PET) films and the application of a detergent-based surfactant liquid, applied to the inner aspect of viewing frame, and addition of filtered vents in the prevention of fogging up of the protective eyewears in a simulated operating room environment. METHODS: Ten volunteer orthopedic surgeons tested three modifications of a poly-hydrocarbon based hermetically sealed eyewear as a) application of a surface-modified anti-fog PET film on the inner aspect of eyewear, b) application of a detergent-based surfactant coating on the inner aspect of the protective eyewear, and c) addition of two filtered vents/holes on each side of the protective eyewear, covered with an N95 mask cutting. The testing was performed while completing a synthetic bone-based surgical task in a simulated operating room environment of 24-26° temperature and humidity between 40 and 70%, for a maximum of 2 h. The duration to the loss of clear visibility (ability to read a newspaper) and workable visibility (ability to perform the surgical task) was recorded for each volunteer. RESULTS: The detergent-based surfactant provided the longest duration of clear visibility (69.3 ± 8.16 min) and the workable visibility was maintained for more than 2 h. The second best durations of clear visibility (31.9 ± 3.75 min) and workable visibility (41.6 ± 5.39 min) were provided by the surface-modified anti-fog PET film. The addition of the filtered vents provided only a marginal improvement in the visibility. CONCLUSION: A detergent-based surfactant coating of the viewing surface provides a simple, inexpensive and effective solution to the problem of fogging of the protective eyewears. Besides this, the workable vision is maintained for a prolonged duration.