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Case Reports
. 2020 Jul;34(7):333-340.
doi: 10.1097/BOT.0000000000001782.

The Orthopaedic Trauma Service and COVID-19: Practice Considerations to Optimize Outcomes and Limit Exposure

Daniel J Stinner  1 , Christopher Lebrun  2 , Joseph R Hsu  3 , A Alex Jahangir  1 , Hassan R Mir  4
Affiliations
Case Reports

The Orthopaedic Trauma Service and COVID-19: Practice Considerations to Optimize Outcomes and Limit Exposure

Daniel J Stinner et al. J Orthop Trauma. 2020 Jul.

Abstract

The COVID-19 pandemic has presented challenges to healthcare systems, including the cancellation and then staged resumption of elective procedures. The orthopaedic trauma community has continued to provide care to patients with acute musculoskeletal injuries that cannot be delayed in all scenarios. This article summarizes and provides relevant information (orthopaedic trauma service, outpatient fracture clinic, inpatient surgery) to the practicing orthopaedic traumatologist on maximizing outcomes while limiting exposure during the pandemic. LEVEL OF EVIDENCE:: Therapeutic Level V. See Instructions for Authors for a complete description of levels of evidence.

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Conflict of interest statement

The authors report no conflict of interest.

Figures

FIGURE 1.
FIGURE 1.
Example of an algorithm from one institution for emergency surgical procedures in trauma patients presenting to the emergency department during the COVID-19 pandemic. Note that all patients are considered COVID unknown and treated as such until test results are confirmed.
FIGURE 2.
FIGURE 2.
Example of an algorithm from one institution for urgent surgical procedures in trauma patients presenting to the emergency department during the COVID-19 pandemic. Note that all urgent surgical trauma patients are initially screened and tested with surgical intervention delayed until test results are finalized.
FIGURE 3.
FIGURE 3.
AP (A) and lateral (B) radiographs are shown of the healed ankle fracture, and it is clearly evident that the syndesmotic screw has backed out (A). A clinical photograph on presentation is shown, where the head of the syndesmotic screw is visible within the wound (C). The screw is shown after removal in the emergency department (D) before wound closure with absorbable sutures and placement of a soft dressing to minimize the need for an in-person immediate postoperative follow-up visit during the COVID pandemic. AP, Anteroposterior.
FIGURE 4.
FIGURE 4.
An AP and 3D reconstruction of the pelvis are shown (A, B), demonstrating the anterior column posterior hemitransverse. Postoperative AP and Judet views (C–E) demonstrate adequate reduction with limited internal fixation. AP, Anteroposterior.
FIGURE 5.
FIGURE 5.
PPE worn in a COVID unknown patient consisting of a surgical hood in conjunction N95 respirator in addition to standard operating room PPE.
See this image and copyright information in PMC

References

    1. WHO Director-General's Opening Remarks at the Media Briefing on COVID-19—11 March 2020. Available at: https://www.who.int/dg/speeches/detail/who-director-general-s-opening-re.... Accessed April 3, 2020.
    1. Coronavirus in the U.S.: Latest Map and Case Count. The New York Times. 2020. Available at: https://www.nytimes.com/interactive/2020/us/coronavirus-us-cases.html. Accessed April 3, 2020.
    1. Vannabouathong C, Devji T, Ekhtiari S, et al. The orthopaedic forum: novel coronavirus COVID-19: current evidence and evolving strategies. J Bone Joint Surg Am. 2020. In press. - PMC - PubMed
    1. van Doremalen N, Bushmaker T, Morris D, et al. Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1. N Engl J Med. 2020. epub ahead of print. - PMC - PubMed
    1. Yeh HC, Jones RK, Muggenburg BA, et al. Characterization of aerosols produced during surgical procedures in hospitals. Aerosol Sci Technol. 1995;22:151–161.

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