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Objectives: Conflicting studies have resulted in several systematic reviews and meta-analyses on the relationship between COVID-19 and body mass index (BMI). Methods: This systematic review of systematic reviews followed an umbrella review design, and preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines; Medical literature analysis and retrieval system online (MEDLINE) and SCOPUS databases were searched for systematic reviews on the topic. A predefined screening and selection procedure was done for the retrieved results based on the population, intervention/interest, comparator, outcome, study (PICOS) framework. Results: The search strategy yielded 6334 citations. With the predefined selection and screening process, 23 systematic reviews were retrieved for inclusion in the present study. Twenty-three (n = 23) systematic reviews met the inclusion criteria. As expected, there was overlap across the reviews in the included primary studies. Available evidence suggests that Class III obesity (morbid obesity) is strongly associated with increased mortality risk in patients with Covid-19. It is difficult to draw a firm conclusion about Class I and Class II obesity due to conflicting outcomes of metanalyses. Increased obesity was consistently associated with increased risk of invasive mechanical ventilation (IMV) in all the reviews with low to moderate heterogeneity. Conclusions: Available evidence suggests that Class III obesity (morbid obesity) is strongly associated with increased mortality risk in patients with Covid-19. Increased BMI is positively associated with the risk of IMV and the severity of COVID- care.
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Background: Three cannulated cancellous screws (CCS) inverted triangle configuration is considered to be the gold standard for management of displaced intracapsular neck femur (ICNF) fractures in young adults. However, some authors have recommended four CCS in diamond configuration in the presence of comminution. However, there are no comparative studies to assess the superiority of one over the other. Therefore, the aim of the present study was to compare the radiological and functional outcomes of displaced, comminuted, ICNF fracture in young adults managed with three screw inverted triangle versus four screw diamond configuration CCS fixation. Material and Methods: Twenty-three patients (group I) with displaced comminuted ICNF fractures were managed with three CCS fixation in inverted triangle fashion between October 2014 and October 2015 and were followed up for a mean duration of 33.5 months (range 25-38 months). Twenty-five patients (group II) with the same inclusion and exclusion criteria were managed with four CCS in diamond configuration between October 2013 and October 2014 and followed up for a mean duration of 33.3 months (range 25-38 months). Radiological outcomes of these patients were compared in terms of union rates and avascular necrosis, while functional outcome was measured by Harris Hip Score (HHS) at a minimum of 24 months. Results: Nineteen patients of group I and 20 patients of group II were available for final follow-up. Mean union time in group I was 15 weeks (12-24 weeks), while in group II, it was 14 weeks (12-24 weeks). There was total of four (4/19) cases of non-union in group I, while it was two (2/20) cases in group II. One patient (1/19) developed avascular necrosis in group I, while two (2/20) developed the same in group II. In group I, the mean HHS was 87.3 (range 84-94) points, while in group II, mean HHS was 93.5 (range 78-96) points. Conclusion: There is no difference in the clinical and radiological outcomes following three screw inverted triangle or four screw diamond configuration CCS fixation of displaced comminuted ICNF fracture in young adults. Thus, we conclude that both three screw inverted triangle or four screw diamond configuration CCS fixation are effective treatment modalities for fracture neck femur with comminution and in the absence of larger studies and long-term follow-up the superiority of one over the other cannot be recommended.
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Introduction: Dislocations of lesser metatarsophalangeal joints (MTPJs) following trauma, inflammatory arthritis, and synovitis are not uncommon. Closed reduction is sufficient in most instances. However, if it is not addressed scientifically in the first instance; rarely, a habitual dislocation may result. Case Report: We present a case of a 43-year-old male patient with painful habitual dorsal dislocation of the fourth MTPJ following a trivial trauma 2 years back, resulting in an inability to wear closed footwear. The patient was managed with the repair of the plantar plate, excision of the neuroma, and transfer of long flexor to dorsum to act as dynamic check rein. At 3 months, he was able to wear shoes and returned to normal activities. There was no radiographic evidence of arthritis or avascular necrosis at 2 years follow-up, and he was comfortably using closed footwear. Conclusion: Isolated dislocation of the lesser MTPJs is an uncommon entity. Traditional practice is closed reduction. However, if the reduction is inadequate, open reduction should be performed to prevent chances of recurrence.
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INTRODUCTION: The COVID-19 pandemic has led to a large body of literature regarding the impact of COVID-19 on orthopaedic care and practice. This rapid review aims to synthesize this published literature to give the orthopaedic fraternity an overview about the best practices that need to be followed during this period. METHODOLOGY: A rapid review was conducted following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement for rapid reviews on the impact of COVID-19 on orthopaedic care and practice. A Pubmed search was done to identify all literature related to the impact of COVID-19 on orthopaedic care and practice, published between December 2019 and October 2020 using a predefined search strategy. The final review included 375 peer-reviewed articles addressing the objectives. RESULTS: The majority of articles were expert opinions ( 37.1%) and narrative reviews (13.1%). There were 17.3% retrospective studies and 2.1% prospective studies with only one randomized control trial and ten systematic reviews. 83.8% of articles had levels of evidence IV and V, 79.5% of the articles were published in core-orthopaedic journals. Maximum publications were from the United States of America (31.7%), followed by India (11.5%). European countries together contributed to 32.0% of all publications. CONCLUSION: COVID-19 has had a significant impact on all aspects of orthopaedic care and practice. The pandemic has affected outpatient clinics, emergency and elective surgery, rehabilitation, resident training, personnel management, use of personal protective equipment, telemedicine and all sub-specialities of orthopaedics. Orthopaedic practice will require the incorporation of new technologies, restructuring of health systems and reorganizing of training programs for optimal patient care. There would also be a need for frequent review of emerging literature to provide evidence-based guidelines to the orthopaedic fraternity which will not only help in mitigation of transmission of disease but also ensure continuity of optimum patient care. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s43465-021-00354-0.
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The prime of COVID-19 forced institutions and hospitals to convert operating rooms into intensive care units. Now as the disease prevalence drops and plateaus in several countries, elective surgeries are being slowly resuming. Such that asymptomatic carriers too would approach hospitals for surgical needs. Coronaviruses are understood to transmit both by droplets and aerosols. Orthopaedic surgery requires regular use of high-speed instruments like power drills, oscillating saws and burrs. Several medical procedures are known to create aerosols thereby exposing the surgeon to contract the virus. Adequate know-how and protective means are mandatory to safeguard the surgical team from inevitable exposure.
