A COMPARISON OF ORTHOPAEDIC TRAUMA CASES OPERATED ON DURING THE COVID-19 PANDEMIC WITH DIFFERENT PERIODS: A SINGLE CENTRE STUDY
Introduction: To compare orthopaedic trauma cases treated surgically in our clinic during the COVID-19 pandemic in Turkey with surgically-treated trauma cases in previous periods, and to discuss these in the light of literature.
Materials and Methods: Patient data of 3 different periods were compared. Group 1 included cases in the time period 11 March - 30 May, when the hospital was operating as a pandemic hospital for the COVID-19 pandemic in Turkey. Group 2 included cases from the equivalent time period the year before the pandemic, thought to have similar patient characteristics, and Group 3 covered the time period immediately before 11 March when COVID-19 was known in the world but there had not been any cases diagnosed in Turkey. Operations were performed in our clinic because of orthopaedic trauma to 186 patients in Group 1, to 262 patients in Group 2, and to 261 patients in Group 3.Â
Results: A decrease of 29% was observed in trauma cases during the pandemic. In Group 1, 62 of 186 patients were aged >65 years, and 43 of these (69%) had a hip fracture. In Group 2, 33 (58%) patients aged >65 years underwent surgery for hip fracture and in Group 3, 60 (75%) patients. The time from hospital admission to surgery was mean 3.76Â±3.55 days in Group 1, 3.18Â±3.08 days in Group 2, and 2.68Â±2.33 days in Group 3 (p=0.017). The number of cases of attempted suicides was 6, 3, 3, respectively in the three groups (p=0.184). 30-day mortality was determined in 5, 3, and 4 cases, respectively (p=0.460).
Conclusions: A decrease in the number of trauma cases was observed during the pandemic. However, there was no such decrease in hip fractures in elderly patients despite the quarantine of those aged >65 years. The workforce of the clinic was divided up during the pandemic for the diagnosis and follow-up of COVID-19 cases and thus there was no reduction in the workload of orthopedists as trauma surgery continued at the rate of 71%. Therefore, it can be considered very important to apply strict regulations which will decrease the risk of the spread of infection, and implement a multidisciplinary work flow for the more rapid discharge of trauma patients. Â
Wu F, Zhao S, Yu B, Chen YM, Wang W, Song ZG et al. A new coronavirus associated with human respiratory disease in China. Nature. 2020;579(7798):265â€“9. doi:10.1038/s41586-020-2008-3.
Zhou P, Yang X-L, Wang X-G, Hu B, Zhang L, Zhang W et al. A pneumonia outbreak associated with a new corona virus of probable bat origin. Nature. 2020;579(7798):270â€“3. doi:10.1038/s41586-020-2012-7.
The Lancet Infectious Diseases. COVID-19, a pandemic or not? Lancet Infect Dis. 2020;20(4):383. https://doi.org/10.1016/s1473-3099(20)30180-8.
Trilla A, Trilla G, Daer C. The 1918 â€œSpanish Fluâ€ in Spain. Clin Infect Dis. 2008;47(5):668â€“73. doi:10.1086/590567.
Webster RG, Govorkova EA. Continuing challenges in influenza. Ann N Y Acad Sci. 2014;1323(1):115â€“39. doi:10.1111/nyas.12462.
Sarac NJ, Sarac BA, Schoenbrunner AR, Janis JE, Harrison RK, Phieffer LS, et al. A review of state guidelines for elective orthopaedic procedures during the COVID-19 Outbreak. J Bone Joint Surg Am. 2020;102(11):942â€“5. doi:10.2106/jbjs.20.00510.
Rothan HA, Byrareddy SN. The epidemiology and pathogenesis of corona virus disease (COVID-19) outbreak. J Autoimmune. 2020;109:102433. doi:10.1016/j.jaut.2020.102433.
Guo YR, Cao QD, Hong ZS, Tan YY, Chen SD, Jin HJ, et al. The origin, transmission and clinical therapies on corona virus disease 2019 (COVID-19) outbreak - an update on the status. Mil Med Res. 2020;7(1):11. doi: 10.1186/s40779-020-00240-0.
Liu K, Chen Y, Lin R, Han K. Clinical features of COVID-19 in elderly patients: A comparison with young and middle-aged patients. J Infect. 2020;80(6):e14â€“8. doi: 10.1016/j.jinf.2020.03.005.
Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical characteristics of Coronavirus disease 2019 in China. N Engl J Med. 2020;382(18):1708â€“20. doi: 10.1056/NEJMoa2002032.
Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult patients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020 ;395(10229):1054â€“62. doi: 10.1016/S0140-6736(20)30566-3.
Rodrigues-Pinto R, Sousa R, Oliveira A. Preparing to perform trauma and orthopaedic surgery on patients with COVID-19. J Bone Joint Surg Am. 2020;102(11):946-50. doi: 10.2106/JBJS.20.00454.
Chang Liang Z, Wang W, Murphy D, Po Hui JH. Novel Coronavirus and orthopaedic surgery: early experiences from Singapore. J Bone Joint Surg Am. 2020;102(9):745-749. doi: 10.2106/JBJS.20.00236.
Ti LK, Ang LS, Foong TW, Ng BSW. What we do when a COVID-19 patient needs an operation: operating room preparation and guidance. Can J Anaesth. 2020;67(6):756â€“8. doi: 10.1007/s12630-020-01617-4.
Ozturk K, Unkar EA, Ozturk AA. Perioperative management recommendations to resume elective orthopaedic surgeries for post-COVID-19 "new normal": Current vision of the Turkish Society of Orthopaedics and Traumatology. Acta Orthop Traumatol Turc. 2020;54(3):228-33. doi: 10.5152/j.aott.2020.20183.
Hernigou J, Morel X, Callewier A, Bath O, Hernigou P. Staying home during "COVID-19" decreased fractures, but trauma did not quarantine in one hundred and twelve adults and twenty eight children and the "tsunami of recommendations" could not lockdown twelve elective operations. Int Orthop. 2020;44(8):1473-80. doi: 10.1007/s00264-020-04619-5.
Zhu Y, Chen W, Xin X, Yin Y, Hu J, Lv H, et al. Epidemiologic characteristics of traumatic fractures in elderly patients during the outbreak of coronavirus disease 2019 in China. Int Orthop. 2020;44(8):1565-70. doi: 10.1007/s00264-020-04575-0.
Munoz Vives JM, Jornet-Gibert M, Camara-Cabrera J, Esteban PL, Brunet L, Delgado-Flores L, et al. Mortality rates of patients with proximal femoral fracture in a worldwide pandemic: preliminary results of the Spanish HIP-COVID observational study. J Bone Joint Surg Am. 2020;102(13):e69. doi: 10.2106/JBJS.20.00686.
Egol KA, Konda SR, Bird ML, Dedhia N, Landes EK, Ranson RA, et al. Increased mortality and major complications in hip fracture care during the COVID-19 pandemic: a New York city perspective. J Orthop Trauma. 2020;34(8):395-402. doi: 10.1097/BOT.0000000000001845.
Catellani F, Coscione A, Dâ€™Ambrosi R, Usai L, Roscitano C, Fiorentino G. Treatment of proximal femoral fragility fractures in patients with COVID-19 during the SARS-CoV-2 outbreak in Northern Italy. J Bone Joint Surg Am. 2020;102(12):e58. doi: 10.2106/JBJS.20.00617.
Kumar Jain V, Lal H, Kumar Patralekh M, Vaishya R. Fracture management during COVID-19 pandemic: A systematic review. J Clin Orthop Trauma. 2020;11(Suppl 4):S431-41. doi: 10.1016/j.jcot.2020.06.035.
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