Journal of Clinical Orthopaedics | Vol 5 | Issue 2 | July-Dec 2020 | page:13-19 | Siddharth Dubey, Sidharath Mohindru, Md. Quamar Azam, Bhaskar Sarkar
Author: Siddharth Dubey , Sidharath Mohindru , Md. Quamar Azam , Bhaskar Sarkar 
 Department of Trauma Surgery AIIMS Rishikesh
Address of Correspondence
Dr. Sidharath Mohindru,
Department of Trauma Surgery AIIMS Rishikesh
Purpose: COVID-19 has affected more than 200 countries and has warranted change in the hospital policies and patient management worldwide. It has brought forward many challenges which were and still are being faced by the health care setup in various nations. There still are many unanswered questions and doubts arising in the minds of orthopaedic trauma surgeons all over regarding this pandemic. This article is an attempt to summarise the current knowledge about COVID-19 in relation to orthopaedic trauma.
Methods: This is a review article presenting concise, collected ideas from exhaustive literature taken from PubMed, Google Scholar and Cochrane reviews. Key words such as “COVID-19”, “Management”, “Orthopaedics” and “Trauma” were used and information from various articles has been presented in a concise manner, including the authors’ own personal experience.
Results: There has been a reduction in major trauma cases presenting to the emergency and a dramatic reduction in trauma admissions during the COVID-19 pandemic. Orthopaedic surgeons need to work alongside other frontline health care workers to tackle this calamity. Hospital resources need to be appropriately used in order to provide optimal patient care alongside minimising the risk of spread of infection to other patients and hospital personnel. The decision to operate needs to be a fine balance between suspected orthopaedics and trauma related complications and worsening of respiratory function in patients who are COVID-19 positive.
Conclusion: As orthopaedic surgeons, it is our moral responsibility to try to reduce the impact of the pandemic in which ever manner possible. There is still a lot to discover and guidelines are constantly changing, so it is also important that surgeons stay up to date on the latest protocols.
Key words: COVID-19. Management. Orthopaedic. Trauma.
1. Wong KC, Leung KS, Hui M. Severe acute respiratory syndrome (SARS) in a geriatric patient with a hip fracture: a case report. JBJS. 2003 Jul 1;85(7):1339-42.
2. Fang D. SARS: facts and considerations for the orthopaedic community. J Orthop Surg (Hong Kong). 2003; 11(1):3-5.
3. Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020; 395(10223):507-13.
4. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020; 395(10229):1054-62.
5. Wong J, Goh QY, Tan Z, et al. Preparing for a COVID-19 pandemic: a review of operating room outbreak response measures in a large tertiary hospital in Singapore. Can J Anaesth. 2020; In Press.
6. Gray AC, White TO, Clutton E, Christie J, Hawes BD, Robinson CM. The stress response to bilateral femoral fractures: a comparison of primary intramedullary nailing and external fixation. J Orthop Trauma. 2020; 23(2):90-7.
7. Lefaivre KA, Starr AJ, Stahel PF, Elliott AC, Smith WR. Prediction of pulmonary morbidity and mortality in patients with femur fracture. J Trauma. 2010; 69(6):1527-35.
8. Steinhausen E, Lefering R, Tjardes T, et al. A risk-adapted approach is beneficial in the management of bilateral femoral shaft fractures in multiple trauma patients: an analysis based on the trauma registry of the German Trauma Society. J Trauma Acute Care Surg. 2014; 76(5):1288-93.
9. Zu ZY, Jiang MD, Xu PP, et al. Coronavirus disease 2019 (COVID-19): a perspective from China. Radiology. 2020; 21:200490.
10. Ruan Q, Yang K, Wang W, Jiang L, Song J. Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Intensive Care Med. 2020; In Press.
11. Sen RK, Tripathy SK, Singh AK. Is routine thromboprophylaxis justified among Indian patients sustaining major orthopedic trauma? A systematic review. Indian J Orthop. 2011; 45(3):197-207.
12. Khak, M., Hakimi, H., Manafi Rasi. A Damage Control Orthopedics in Multitrauma Patients: A Pediatric Case Presentation and Literature Review. Trauma Monthly. 2017; 22(3):e32856.
13. Randelli PS, Compagnoni R. Management of orthopaedic and traumatology patients during the Coronavirus disease (COVID-19) pandemic in northern Italy. Knee Surgery, Sports Traumatology, Arthroscopy. 2020 Apr 25:1.
14. Mavrogenis AF, Quaile A, Scarlat MM. The virus crisis affects Orthopaedic surgery and scientific activities worldwide. International Orthopaedics. 2020 May 1:1.
15. Day M. Covid-19: ibuprofen should not be used for managing symptoms, say doctors and scientists. BMJ. 2020; 368:m1086
16. Steroid Injections and NSAIDs COVID 19. British Association of Spine Surgeons (BASS) communication.19.03.2020.
17. Yeh HC, Jones RK, Muggenburg BA, et al. Characterization of aerosols produced during surgical procedures in hospitals. Aerosol Sci Technol. 1995; 22:151–161.
18. Schwartz A, Wilson J, Boden S, et al. Managing resident workforce and education during the COVID-19 pandemic. J Bone Joint Surg Am. 2020; In press.
19. Chavez S, Long B, Koyfman A, et al. Coronavirus disease (COVID-19): A primer for emergency physicians. Am J Emerg Med. 2020; epud ahead of print.
20. Stinner DJ, Lebrun C, Hsu JR, Jahangir AA, Mir HR. The orthopaedic trauma service and COVID-19: practice considerations to optimize outcomes and limit exposure. Journal of orthopaedic trauma. 2020 Apr 13.
21. Sathiyakumar V, Apfeld JC, Obremskey WT, et al. Prospective randomized controlled trial using telemedicine for follow-ups in an orthopaedic trauma population: a pilot study. J Orthop Trauma. 2015; 29:e139–e145.
22. Hollander J, Carr B. Virtually perfect? Telemedicine for COVID-19. N Engl J Med. 2020; epub ahead of print.
23. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. The lancet. 2020 Mar 11.
24. Khak M, Manafi-Rasi A, Oryadi Zanjani L, Nabian MH. Trauma orthopedic surgeries in COVID-19 pandemic; a trauma management algorithm. The Archives of Bone and Joint Surgery. 2020; 8(Covid-19 Special Issue).
25. Chhabra HS, Bagaraia V, Keny S, et al. COVID-19: Current Knowledge and Best Practices for Orthopaedic Surgeons. Indian J Orthop. 2020 May 18; 1.
26. Jain VK, Vaishya R. COVID-19 and orthopaedic surgeons: the Indian scenario. Tropical Doctor. 2020; 50(2):108-10.
27. Awad ME, Rumley JC, Vazquez JA, Devine JG. Perioperative Considerations in Urgent Surgical Care of Suspected and Confirmed COVID-19 Orthopaedic Patients: Operating Room Protocols and Recommendations in the Current COVID-19 Pandemic. JAAOS-Journal of the American Academy of Orthopaedic Surgeons. 2020; 28(11):451-63.
28. Massey PA, McClary K, Zhang AS, Savoie FH, Barton RS. Orthopaedic Surgical Selection and Inpatient Paradigms During the Coronavirus (COVID-19) Pandemic. The Journal of the American Academy of Orthopaedic Surgeons. 2020 Apr 15.
29. Iyengar KP, Jain VK, Vaish A, Vaishya R, Maini L, Lal H. Post COVID-19: Planning strategies to resume orthopaedic surgery–challenges and considerations. Journal of Clinical Orthopaedics and Trauma. 2020 May 4.
31. Reid, David. “India confirms its first coronavirus case”. CNBC. Retrieved 28 March 2020
32. Ebrahim SH, Ahmed QA, Gozzer E, Schlagenhauf P, Memish ZA. Covid-19 and community mitigation strategies in a pandemic. 2020.
33. Pfeifer R, Kalbas Y, Coimbra R, et al. Indications and interventions of damage control orthopedic surgeries: an expert opinion survey. European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society. 2020.
34. Sarac NJ, Sarac BA, Schoenbrunner AR, et al. A review of state guidelines for elective orthopaedic procedures during the COVID-19 outbreak. JBJS. American Volume. 2020 Apr 13.
35. Parvizi J, Gehrke T, Krueger CA, Chisari E, Citak M, Van Onsem S, Walter WL. Resuming elective orthopaedic surgery during the COVID-19 pandemic: guidelines developed by the International consensus group (ICM). JBJS. 2020 Jul 15;102(14):1205-12.
36. Cucinotta D, Vanelli M. WHO declares COVID-19 a pandemic. Acta bio-medica: Atenei Parmensis. 2020; 91(1):157-60.
37. Hampton M, Clark M, Baxter I, Stevens R, Flatt E, Murray J, Wembridge K. The effects of a UK lockdown on orthopaedic trauma admissions and surgical cases: A multicentre comparative study. Bone & Joint Open. 2020; 1(5):137-43.
38. Fahy S, Moore J, Kelly M, Flannery O, Kenny P. Analysing the variation in volume and nature of trauma presentations during COVID-19 lockdown in Ireland. Bone & Joint Open. 2020; 1(6):261-6.
|How to Cite this article: Dubey S, Mohindru S, Azam Md. Q, Sarkar B. Orthopaedic and trauma management in covid-19 era: common problems and their probable solution in literature, a narrative review. Journal of Clinical Orthopaedics July-Dec 2020;5(2):13-19.|