Redeployment of specialist surgeons in the COVID-19 pandemic in a general hospital: critical issues and suggestions.

BACKGROUND AND AIM: to gain experience and highlight any margins for improvement, we outlined the role played by specialist surgeons (with particular reference to orthopedic surgeons), redeployed in treating COVID-19 patients in the Emergency Department of a general hospital, with severe overcrowding due to the massive and continuous arrival of patients Methods: "on the field" experience of the Authors is reported, followed by a narrative review of the literature, mainly on the topic of health-personnel redeployment during an emergency Results: a brief chronological discussion of the progressive reorganization of the hospital, in relation to the progress of the epidemic in the area, is reported, with specific reference to the experience of orthopedic and other branches specialist surgeons, that was characterized by a high degree of uncertainty about what to do, worsened by organizational difficulties due to the incessant arrival of patients and subsequent overcrowding. Observations relating to the critical aspects that have emerged and the various solutions proposed or implemented, if they have been identified, as well as the problems still open, are then made and compared to current literature. CONCLUSIONS: The most significant aspect that we have tried to outline is the organizational difficulty, due to the rapid and unpredictable change in the situation: greater efficiency and flexibility, seen as the ability to overcome bureaucratic, logistical, regulatory or budgetary obstacles that prevent the rapid changes made necessary by the epidemic, could perhaps help to face better any subsequent pandemic wave, like the fierce one ongoing at the present moment.

Surgical treatment of peri-prosthetic femur fractures with dedicated NCB plates: our experience.

BACKGROUND AND AIM OF THE WORK: The incidence of periprostethic femur fractures has increased over the last years; the treatment includes an open reduction and internal fixation or revision implant. The treatment of these fractures can be complex, expensive and associated with risks of systemic and local complications. METHODS: We evaluated clinical and radiological results in patients treated in our department for periprosthetic femoral fractures from 2011 to 2017. We included 52 cases of periprosthetic fractures regardless of their classification with a mean follow-up of 2 years. The analisys of the result was performed using Harris Hip Score and searching for radiographic signs of loosening, infections or mechanical failure of the implants. RESULTS: There was no evidence of septic complications or mechanical failure in cases treated. The average HHS was equal to 92 points with a certificate pain relief and a sufficient independence in daily living activities. CONCLUSIONS: The treatment of periprosthetic fractures is complex: it depends on type of fracture, on stability of the stem and on the bone quality. A right classification of the fractures, a good experience of the surgeon in prosthetic and trauma surgery is the basis for the best treatment.