Retrograde calcaneo-talo-tibial nail, subtalar arthrodesis and fibula transposition in the treatment of traumatic bone and articulatory defect of the distal tibia and talocrural joint: A case report.

High-energy trauma of the lower leg can cause conditions such as bone defects, loss of the articular surface or a complex soft tissue injury. Given the type of the injury, as well as the often poor general status of the patient, the initial treatment usually consists of debridement and external fixation. The role of the retrograde calcaneo-talo-tibial nail is acknowledged in the treatment of post-traumatic arthritis of the talocrural joint, rheumatic arthritis, the neuropathic joint as well as some other conditions. We present a case of a thirty-five-year-old man with a lower leg fracture and significant bone defect associated with the loss of the articular surface of the distal tibia which was treated with a retrograde calcaneo-talo-tibial nail. Due to the lack of an adequate implant on the market, an inversely introduced tibial nail was used. Following the nailing of the fracture and the recovery of the soft tissue, transposition of the ipsilateral fibula was performed. Nowadays, different methods for bone defect reconstruction are available such as distraction osteogenesis, bone transport, and the Masquelet technique. However, the calcaneo-talo-tibial nail and transposition of the fibula is another feasible and effective option, especially for unreconstructable joint surfaces.

The impact of the COVID-19 pandemic on resident physicians: A cross-sectional study.

BACKGROUND: COVID-19 presents a threat to the mental health of the medical staff working with COVID-19 patients. OBJECTIVE: To investigate the impact of working during the COVID-19 pandemic on resident physicians. METHODS: The study was conducted via anonymous online survey and included resident physicians. The survey contained questions about sociodemographic information, general job satisfaction during the COVID-19 pandemic, and the impact of the COVID-19 pandemic on their personal lives. RESULTS: This study included a response from 728 resident physicians. The majority of residents rated that the COVID-19 pandemic had a mostly negative impact on their satisfaction with professional life (59.9%) and quality of work (62.8%), their personal lives (44.7%) and quality of life (57.1%). Half of all residents indicated that they did not have enough personal protective equipment (PPE). About one-third of residents indicated that the level of stress at work during the COVID-19 pandemic was higher. CONCLUSIONS: Working as resident physicians during COVID-19 pandemic had a negative effect on participants' professional and personal lives. Residents did not have all the necessary PPE nor felt safe working with patients with suspected or proven COVID-19. Further action is needed to provide support for physician residents working during the COVID-19 pandemic.