Journal of Orthopedic and Spine Trauma
Volume:6 Issue: 2, Jun 2020

The recent outbreak of the coronavirus disease-2019 (COVID-19) in China has rapidly spread throughout the world and significantly affected orthopedic and trauma cases all over the world. This study aims to evaluate the impact of the COVID-19 pandemic on orthopedic and trauma cases at Sina Hospital, Tehran, Iran.

The study was conducted using the database of Orthopedics Department at Sina Hospital. It consisted of data before four and after four months of the COVID-19 outbreak. The demographic data of the patients with orthopedic problems and trauma, including sex, age, and type and mechanism of trauma was studied.

In total, data of 1033 patients was studied, including 597 and 436 patients before and after the COVID-19 outbreak, respectively. In this period of time, the potion of patients with laceration and upper limb injuries increased significantly (P = 0.007 and P = 0.002, respectively). Additionally, the proportion of low energy trauma and high energy trauma respectively increased and decreased (P = 0.055).

Because of the outbreak and consequent lockdown in many countries, cases of orthopedics and trauma very significantly reduced. This resulted in less workload on orthopedic surgeons and residents during the COVID-19 pandemic. Decreases in trauma cases and road traffic accidents were also reported by most centers around world.

Since the outbreak of the novel coronavirus disease-2019 (COVID-19) pandemics many orthopedic elective surgeries have been postponed all over the world. There are several guidelines for resuming elective surgeries during this crisis. In our center (Imam Khomeini hospital, Tehran, Iran), we resumed total joint arthroplasty (TJAs)surgeries using preoperative history taking and physical examination. Here, we report our experience.

From February 2020 to August 2020, we included 165 patients who underwent TJA [70 total hip arthroplasty (THA)and 95 total knee arthroplasty (TKA)] in Imam Khomeini hospital, a referral center for COVID-19.We followed each patient from the day of hospitalization to two weeks after discharge by telephone forclinical symptoms of COVID-19.

Only one patient became infected with COVID-19 a week after discharge from the hospital, and other patients did not show any sign or symptoms within two weeks after the discharge.

We recommend resuming the elective surgeries usinga careful physical examination and medical history for all patients, and in suspicious cases, referring to a specialized COVID-19 clinic for further investigation.

The novel coronavirus disease-2019 (COVID-19) has become a significant worldwide problem since January 2019. Hospitals have spent most of their time and logistics on patients with COVID-19. During this crisis, many healthcare providers have been infected with the disease, and occasionally, some wards and operating rooms were shut down as a result. Here, we explainour experience with the healthcare staff involvement with COVID-19in our hospital.

As a referral tertiary center, Imam Khomeini Hospital (Tehran, Iran) has 4,200 health-care workers (HCWs). From February 20, 2020 to August 21, 2020, we investigated the hospital database for COVID-19 involvement among the staff.

During the study period, 973 (23%) hospital HCWs were detected with COVID-19, 378 (9%) of whom were involved between June 21 and July 21, 2020. In the orthopedic department, 20 of 43 (46%) HCWs were infected with COVID-19.

We believe that the increase in the incidence of the disease and higher risk of exposure is a highly noticeable factor which should be addressed by the administrative health officials.

The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused the largest global healthcare crisis of the last century since its emergence in December 2019. As more of the condition’s chronicity became evident and the government policies changed, the unlocking of the orthopedic wards seemed necessary. In this study, we decided to share our experience regarding the unlocking of our orthopedic ward in the largest tertiary referral hospital of Iran and to explain its negative and positive consequences.

This observational study was done in Imam Khomeini Hospital Complex, Tehran, Iran, from April to August 2020. We extracted the data regarding the number of elective/trauma operations, emergency patients, and morning report sessions attendance from our registry database. The data were analyzed and plotted using Microsoft Excel 365.

The mean weekly number of orthopedic operations decreased from 50 for elective and 30 for trauma operations in January 2020 to almost zero for both in late March and early April 2020 [the first coronavirus disease 2019 (COVID-19) peak]. Following the department unlocking, the mean weekly elective and trauma operations returned to 50 and 20 by mid-June, respectively. The mean weekly orthopedic emergency visits followed the same order with decrease from 50 to almost zero in late March and increase to 70 in mid-June. However, by the beginning of the second wave, it decreased to almost 38 in early July and further to 28 in late July bythe end of the second wave.

The unlocking of the orthopedic department in a tertiary referral hospital during the COVID-19 pandemic is possible, provided that there is a set of protocols for patient care in the ward, emergency room (ER), operating room (OR), and clinic during the pandemic.

Patients with asymptomatic coronavirus disease 2019 (COVID-19) can transmit the disease to others.Since the trauma patients represent a portion of society and can be asymptomatic carriers of COVID-19, it is essential for medical staff to use precautions when managing all trauma patients with or without symptoms of COVID-19.

In this article, we discuss three patients with bone fractures who had no previous symptoms of COVID-19. Two cases were old patients with intertrochanteric fractures, and the other one was a young man with a distal clavicular fracture. All patients were diagnosed incidentally in the course of the admission.

Emergency room (ER) personnel and orthopedic surgeons should be aware of asymptomatic COVID-19 cases. It isimportant to use standard personal protective equipment (PPE) during the evaluation of all patients with orthopedic trauma toprevent disease spread.

During the outbreak of the novel coronavirus disease 2019 (COVID-19), SinaHospital in Tehran, Iran, dedicated a majority of its facilities and workforce to fight this crisis. Meanwhile, our academic trauma center continued to admit emergency trauma patients.

In this case series, we tried to discuss five previously healthy trauma patients who underwent orthopedic surgery and were diagnosed with COVID-19 later. Also, we described our detailed protocol for the management of orthopedic patients during the pandemic.

During COVID-19 time, we continued to provide our best service to the trauma patients while keeping our personnel as far as possible from direct contact with the patients until it was necessary.

Coronavirus disease 2019 (COVID-19) outbreak had some adverse effects on the management and treatment of patients with different medical conditions in several ways, and one of the most important and devastating ones is a delay in seeking medical care.

During the first months of the outbreak, we had met seven patients with orthopedic problems and significant delays in receiving treatment which completely changed the treatment plan, course of the disease, and outcome.

As the COVID-19 pandemic has adverse effects on the management of orthopedic patients, like other medical conditions, it is necessary to make decisions and to implant some strategies to provide safe and effective care for patients with orthopedic conditions.