Orthopedic Trauma Surgeries in COVID-19 Pandemic; A Trauma Management Algorithm

Document Type : SHORT COMMUNICATION

Authors

1 Department of Orthopedic and Trauma Surgery, Guilan University of Medical Sciences, Rasht, Iran

2 Department of Orthopedic and Trauma Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran

3 Department of Orthopedic and Trauma Surgery, Tehran University of Medical Sciences, Tehran, Iran

Abstract

After the COVID-19 outbreak worldwide, we will sooner or later encounter trauma patients with COVID-19 in the
developing countries. It is a challenging decision-making process for an orthopedic surgeon to provide the patients with
the best practice in the crisis. Here we discuss the issue in terms of clinical severity of COVID-19 pneumonia, priority
of orthopedic surgical trauma procedures and standard of care for the treatment of trauma injuries. We finally propose
an algorithm for better management of trauma patients in the setting of COVID-19 mass spread.
Level of evidence: IV

Keywords


1. World Health Organization. Coronavirus disease
(COVID-2019) situation reports. Available at: URL:
https://www.who.int/emergencies/diseases/novelcoronavirus-
2019/situation-reports; 2020.
2. McCloskey B, Zumla A, Ippolito G, Blumberg L,
Arbon P, Cicero A, et al. Mass gathering events and
reducing further global spread of COVID-19: a
political and public health dilemma. Lancet. 2020;
395(10230):1096-9.
3. Cheng ZJ, Shan J. 2019 Novel coronavirus: where we
are and what we know. Infection. 2020; 48(2):155-63.
4. Wong KC, Leung KS, Hui M. Severe acute respiratory
syndrome (SARS) in a geriatric patient with a hip
fracture. A case report. J Bone Joint Surg Am. 2003;
85(7):1339-42.
5. Fang D. SARS: facts and considerations for the
orthopaedic community. J Orthop Surg (Hong Kong).
2003; 11(1):3-5.
6. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, 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.
7. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, 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.
8. 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; In Press.
9. Wong J, Goh QY, Tan Z, Lie SA, Tay YC, Ng SY, 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.
10. 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. 2009;
23(2):90-7.
11. 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.
12. Steinhausen E, Lefering R, Tjardes T, Neugebauer EA,
Bouillon B, Rixen D, 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.
13. Zu ZY, Jiang MD, Xu PP, Chen W, Ni QQ, Lu GM, et al.
Coronavirus disease 2019 (COVID-19): a perspective
from China. Radiology. 2020; 21:200490.
14. 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.
15. 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.
16. 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.
17. Tahmasebi MN, Nabian MH. How to Continue Essential
Orthopedic Services during COVID-19 Crisis? The
Archives of Bone and Joint Surgery. 2020; 8 (Covid-19
Special Issue):295-6.