Orthopedic telemedicine encounter during the COVID-19 pandemic: A cautionary tale

Abstract

The COVID-19 pandemic has necessitated increased use of telemedicine for diagnosis and management of musculoskeletal disorders. We describe the virtual/telemedicine encounter and management of a patient with knee pain initially diagnosed as gonarthrosis but that actually resulted from an impending pathologic fracture of the femur. Definitive diagnosis and treatment occurred only after completion of the impending fracture. The multiple factors making telemedicine encounters challenging which contributed to this outcome are highlighted. Orthopedists need awareness of these challenges and must take steps to mitigate the risk of complications possible with continued increased utilization of telemedicine during this pandemic and beyond.

Keywords: Coronavirus; Delayed diagnosis; Impending fracture; Orthopedic surgery; Telemedicine.

Fig. 1

Knee radiographs. Sunrise (A), anteroposterior (B) and lateral (C) view of the patient's right knee.

Fig. 2

Anteroposterior (A) and lateral (B) radiographs of the right femur at site of pathologic fracture.

Fig. 3

Intraoperative fluoroscopy (A–D) of the right femur after fixation of pathologic fracture with cephalomedullary device.

Fig. 4

Histology of biopsy from femoral lesion obtained at time of reduction and fixation of femur. (A) Infarcted tumor (left) with adjacent marked acute inflammation (right) (H&E stain; original magnification ×200). (B) Foci of viable metastatic follicular thyroid carcinoma. Note the uniform tumor cells with dark nuclei and eosinophilic cytoplasm arranged in nests and small follicles (H&E stain; original magnification ×400).