Purpose
This article aims to share northern Italy’s experience in hospital re-organization and management of clinical pathways for traumatic and orthopaedic patients in the early stages of the ...COVID-19 pandemic.
Methods
Authors collected regional recommendations to re-organize the healthcare system during the initial weeks of the COVID-19 pandemic in March, 2020. The specific protocols implemented in an orthopaedic hospital, selected as a regional hub for minor trauma, are analyzed and described in this article.
Results
Two referral centres were identified as the hubs for minor trauma to reduce the risk of overload in general hospitals. These two centres have specific features: an emergency room, specialized orthopaedic surgeons for joint diseases and trauma surgeons on-call 24/7. Patients with trauma without the need for a multi-disciplinary approach or needing non-deferrable elective orthopaedic surgery were moved to these hospitals. Authors report the internal protocols of one of these centres. All elective surgery was stopped, outpatient clinics limited to emergencies and specific pathways, ward and operating theatre dedicated to COVID-19-positive patients were implemented. An oropharyngeal swab was performed in the emergency room for all patients needing to be admitted, and patients were moved to a specific ward with single rooms to wait for the results. Specific courses were organized to demonstrate the correct use of personal protection equipment (PPE).
Conclusion
The structure of the orthopaedic hubs, and the internal protocols proposed, could help to improve the quality of assistance for patients with musculoskeletal disorders and reduce the risk of overload in general hospitals during the COVID-19 pandemic.
Purpose
This study aimed to evaluate the impact of the coronavirus disease 2019 (COVID-19) pandemic on orthopaedic and trauma surgery training in Europe by conducting an online survey among ...orthopaedic trainees.
Methods
The survey was conducted among members of the Federation of Orthopaedic and Trauma Trainees in Europe (FORTE). It consisted of 24 questions (single-answer, multiple-answer, Likert scales). Orthopaedic trainees’ demographic data (six questions), clinical role changes (four questions), institutional changes due to the COVID-19 pandemic (nine questions), and personal considerations (five questions) were examined.
Results
Three hundred and twenty-seven trainees from 23 European countries completed the survey. Most trainees retained their customary clinical role (59.8%), but a significant number was redeployed to COVID-19 units (20.9%). A drastic workload decrease during the pandemic was reported at most institutions. Only essential activities were performed at 57.1% of institutions and drastic disruptions were reported at 36.0%. Of the respondents, 52.1% stated that faculty-led education was restricted and 46.3% pursued self-guided learning, while 58.6% stated that surgical training was significantly impaired. Concerns about the achievement of annual training goals were expressed by 58.2% of the participants, while 25.0% anticipated the need for an additional year of training.
Conclusions
The SARS-CoV-2 pandemic significantly affected orthopaedic and trauma training in Europe. Most trainees felt the decrease in clinical, surgical, and educational activities would have a detrimental effect on their training. Many of them consulted remote learning options to compensate training impairment, stating that after the COVID-19 pandemic electronic educational approaches may become more relevant in future.
Purpose
With the COVID-19 crisis, recommendations for personal protective equipment (PPE) are necessary for protection in orthopaedics and traumatology. The primary purpose of this study is to review ...and present current evidence and recommendations for personal protective equipment and safety recommendations for orthopaedic surgeons and trauma surgeons.
Methods
A systematic review of the available literature was performed using the keyword terms “COVID-19”, “Coronavirus”, “surgeon”, “health-care workers”, “protection”, “masks”, “gloves”, “gowns”, “helmets”, and “aerosol” in several combinations. The following databases were assessed: Pubmed, Cochrane Reviews, Google Scholar. Due to the paucity of available data, it was decided to present it in a narrative manner. In addition, participating doctors were asked to provide their guidelines for PPE in their countries (Austria, Luxembourg, Switzerland, Germany, UK) for consideration in the presented practice recommendations.
Results
World Health Organization guidance for respiratory aerosol-generating procedures (AGPs) such as intubation in a COVID19 environment was clear and included the use of an FFP3 (filtering face piece level 3) mask and face protection. However, the recommendation for surgical AGPs, such as the use of high-speed power tools in the operating theatre, was not clear until the UK Public Health England (PHE) guidance of 27 March 2020. This guidance included FFP3 masks and face protection, which UK surgeons quickly adopted. The recommended PPE for orthopaedic surgeons, working in a COVID19 environment, should consist of level 4 surgical gowns, face shields or goggles, double gloves, FFP2-3 or N95-99 respirator masks. An alternative to the mask, face shield and goggles is a powered air-purifying respirator, particularly if the surgeons fail the mask fit test or are required to undertake a long procedure. However, there is a high cost and limited availabilty of these devices at present. Currently available surgical helmets and toga systems may not be the solution due to a permeable top for air intake. During the current COVID-19 crisis, it appeared that telemedicine can be considered as an electronic personal protective equipment by reducing the number of physical contacts and risk contamination.
Conclusion
Orthopaedic and trauma surgery using power tools, pulsatile lavage and electrocautery are surgical aerosol-generating procedures and all body fluids contain virus particles. Raising awareness of these issues will help avoid occupational transmission of COVID-19 to the surgical team by aerosolization of blood or other body fluids and hence adequate PPE should be available and used during orthopaedic surgery. In addition, efforts have to be made to improve the current evidence in this regard.
Level of evidence
IV.
Inequity exists in surgical training and the workplace. The Eastern Association for the Surgery of Trauma (EAST) Equity, Quality, and Inclusion in Trauma Surgery Ad Hoc Task Force (EAST4ALL) sought ...to raise awareness and provide resources to combat these inequities.
A study was conducted of EAST members to ascertain areas of inequity and lack of inclusion. Specific problems and barriers were identified that hindered inclusion. Toolkits were developed as resources for individuals and institutions to address and overcome these barriers.
Four key areas were identified: (1) harassment and discrimination, (2) gender pay gap or parity, (3) implicit bias and microaggressions, and (4) call-out culture. A diverse panel of seven surgeons with experience in overcoming these barriers either on a personal level or as a chief or chair of surgery was formed. Four scenarios based on these key areas were proposed to the panelists, who then modeled responses as allies.
Despite perceived progress in addressing discrimination and inequity, residents and faculty continue to encounter barriers at the workplace at levels today similar to those decades ago. Action is needed to address inequities and lack of inclusion in acute care surgery. The EAST is working on fostering a culture that minimizes bias and recognizes and addresses systemic inequities, and has provided toolkits to support these goals. Together, we can create a better future for all of us.
Aims The aim of this study was to assess the current evidence relating to the benefits of virtual reality (VR) simulation in orthopaedic surgical training, and to identify areas of future research. ...Materials and Methods A literature search using the MEDLINE, Embase, and Google Scholar databases was performed. The results' titles, abstracts, and references were examined for relevance. Results A total of 31 articles published between 2004 and 2016 and relating to the objective validity and efficacy of specific virtual reality orthopaedic surgical simulators were identified. We found 18 studies demonstrating the construct validity of 16 different orthopaedic virtual reality simulators by comparing expert and novice performance. Eight studies have demonstrated skill acquisition on a simulator by showing improvements in performance with repeated use. A further five studies have demonstrated measurable improvements in operating theatre performance following a period of virtual reality simulator training. Conclusion The demonstration of 'real-world' benefits from the use of VR simulation in knee and shoulder arthroscopy is promising. However, evidence supporting its utility in other forms of orthopaedic surgery is lacking. Further studies of validity and utility should be combined with robust analyses of the cost efficiency of validated simulators to justify the financial investment required for their use in orthopaedic training. Cite this article: Bone Joint J 2018;100-B:559-65.
Se evaluó la frecuencia de las lesiones del esqueleto apendicular diagnosticado en caninos en el área de radiología de la Clínica de Animales Menores de la Facultad de Medicina Veterinaria de la ...Universidad Nacional Mayor de San Marcos durante el periodo 2012-2016. Se analizaron 2552 registros radiológicos realizados en el esqueleto apendicular. De estos, 43.3% (n=1106) presentaron lesiones traumatológicas, 23.2% (n=591) lesiones ortopédicas, 12.7% (n=323) lesiones degenerativas, 2.7% (n=69) lesiones compatibles con osteomielitis, 1.7% (n=42) lesiones compatibles con neoplasias, y 0.5% (n=13) lesiones compatibles con osteodistrofia hipertrófica. Entre las lesiones traumatológicas, las estructuras ósea con mayor frecuencia de fractura fueron la pelvis (35.1%; n=388) y el fémur (26.9%; n=298) y entre las lesiones ortopédicas fueron la luxación patelar (36.9%; n=218) y la displasia de cadera (36.6%; n=216). Las lesiones traumatológicas fueron más frecuentes en caninos juveniles (46.5%), y las lesiones ortopédicas en adultos maduros (42.2%). Los machos presentaron mayor frecuencia de lesiones traumatológicas (58.3%) y ortopédicas (61.2%) en comparación con las hembras; en cambio, las lesiones traumatológicas fueron más comunes en caninos mestizos (60.3%), y las ortopédicas en caninos de raza pura (70.0%).
The COVID-19 pandemic has caused all countries to limit their activities to reduce transmission. In the orthopedic and traumatology services, the COVID-19 pandemic has limited the number of ...non-emergency surgeries, rescheduling activities, limiting hospitalization, etc. This study aimed to quantify the change in the number of visits, trauma cases, surgeries, and telemedicine in orthopedic and traumatology services. The search was carried out on the PubMed, Research Gate, MedRxiv, Elsevier, Link Springer, and Medline databases. The inclusion criteria of the articles used were observational studies. The assessment of the articles’ validity was carried out using a checklist made by the Joanna Briggs Institute. The data being synthesized is limited to quantitative data only. From the 19 articles meeting inclusion criteria, it was found that there was a decrease in the number of visits by 22.4%-86.1%. In additions, there is a decrease in the number of trauma cases by 21.1%-91.2%, lower limb trauma by 20%-77.7 %, upper limb trauma by 6%-78.8%, surgeries by 21.7%-88.8%, elective surgeries by 50%-100%, a change in the number of trauma cases and hip fractures, and an increase in the number of telemedicine application by 9.28%-21.87% in COVID-19 pandemic periode (2020) compared to the pre-COVID-19 pandemic periode (2019 or less). The COVID-19 pandemics affecting the orthopedic and traumatology services decreased the number of visits, especially trauma cases, and surgical intervention
This study aimed to build a matrix of orthopedics and traumatology skills focusing on the musculoskeletal system for graduates of a medical course in Brazil.
The study used the e-Delphi methodology ...to retrieve opinions anonymously. The first proposal included 42 items determined at a bibliographical review and their epidemiological relevance. This proposal was available via Google Forms, and we sent it using the instant messaging application WhatsApp. We grouped the panel of 26 specialists into three categories: Orthopedics and Traumatology professors, Primary Care doctors, and Emergency Physicians. We reached a consensus after three rounds, with at least 75% agreement between the items initially presented. We also considered the following four indicators: prerequisite, essential, desirable, and advanced skills.
We created a matrix with 34 musculoskeletal system-related skills, including diagnostic and management actions for all age groups.
We devised a skill matrix in Orthopedics and Traumatology for medical graduation for complete or partial use according to the institutional curriculum.
Blunt cerebrovascular injuries (BCVIs) are associated with significant morbidity and mortality. This guideline evaluates several aspects of BCVI diagnosis and management including the role of ...screening protocols, criteria for screening cervical spine injuries, and the use of antithrombotic therapy (ATT) and endovascular stents.
Using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology, a taskforce of the Practice Management Guidelines Committee of the Eastern Association for the Surgery of Trauma performed a systematic review and meta-analysis of currently available evidence. Four population, intervention, comparison, and outcome questions were developed to address diagnostic and therapeutic issues relevant to BCVI.
A total of 98 articles were identified. Of these, 23 articles were selected to construct the guidelines. In these studies, the detection of BCVI increased with the use of a screening protocol versus no screening protocol (odds ratio OR, 4.74; 95% confidence interval CI, 1.76-12.78; p = 0.002), as well as among patients with high-risk versus low-risk cervical spine injuries (OR, 12.7; 95% CI, 6.24-25.62; p = 0.003). The use of ATT versus no ATT resulted in a decreased risk of stroke (OR, 0.20; 95% CI, 0.06-0.65; p < 0.0001) and mortality (OR, 0.17; 95% CI, 0.08-0.34; p < 0.0001). There was no significant difference in the risk of stroke among patients with Grade II or III injuries who underwent stenting as an adjunct to ATT versus ATT alone (OR, 1.63; 95% CI, 0.2-12.14; p = 0.63).
We recommend using a screening protocol to detect BCVI in blunt polytrauma patients. Among patients with high-risk cervical spine injuries, we recommend screening computed tomography angiography to detect BCVI. For patients with low-risk risk cervical injuries, we conditionally recommend performing a computed tomography angiography to detect BCVI. We recommend the use of ATT in patients diagnosed with BCVI. Finally, we recommend against the routine use of endovascular stents as an adjunct to ATT in patients with Grade II or III BCVIs.
Guidelines, Level III.
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