Fracture Surgery in Known COVID-19 Infected Patients: What Are the Challenges?

Document Type : RESEARCH PAPER

Authors

1 Department of Orthopedic Surgery, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

2 Joint Reconstruction Research Center (JRRC), Imam Khomeini Hospital Complex, Tehran University of Medical Science, Tehran, Iran

3 Department of Orthopedic Surgery, Imam Hossein Hospital,Shahid Beheshti University of Medical Sciences, Tehran, Iran

4 Orthopedic Research Center, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran

5 Department of Orthopedic Surgery, Kermanshah University of Medical Sciences, Kermanshah Iran

Abstract

Background: Surgery in the time of COVID-19 pandemic is a challenging issue while treatment of affected fracture
patients is inevitable. The present study summarizes the challenges that an orthopedic surgeon is confronting during
the surgical treatment of fracture patients with concomitant COVID-19 infection.
Methods: Demographic and fracture related data of 13 fracture patients with concomitant COVID-19 infection who
were treated with surgery was collected from three trauma centers in Tehran and Kermanshah cities from 21, February
2020 to April 3, 2020.
Results: All patients were male with mean age of 38.6±19.5 years. Eight patients had high energy fracture and seven
patients had multiple fractures and trauma. Wrist and hand were the common sites of fracture following hip and pelvis. The
mean interval time period between the diagnosis of COVID-19 infection and surgery was 2.3±1.5 days. Before surgery, all
patients except one had been admitted to the corona dedicated wards, while two patients were admitted to the intensive
care unit (ICU). One of the ICU admitted patients died. All the 12 alive patients remained in home isolation after discharge.
Conclusion: Fracture surgery in COVID-19 patients has many challenges such as lack of medical resources, delay
of surgery, medial staff fear, and patient isolation. However, a multidisciplinary approach using all potential hospital
resources would lead to successful operation and acceptable outcome.
Level of evidence: III

Keywords

References

1. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, Xiang J, Wang Y,
Song B, Gu X, Guan L. 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.
2. Bedford J, Enria D, Giesecke J, Heymann DL,
Ihekweazu C, Kobinger G, Lane HC, Memish Z, Oh
MD, Schuchat A, Ungchusak K. COVID-19: towards
controlling of a pandemic. The Lancet. 2020 Mar 17.
3. WHO official site. https://who.sprinklr.com
4. Shariyate MJ, Kachooei AR. Association of New
Coronavirus Disease with Fragility Hip and Lower
Limb Fractures in Elderly Patients. Arch Bone Jt
Surg. 2020; 8 (Supplement 1): 297-301.
5. Shahbazi F, Soori H, Khodakarim S, Ghadirzadeh MR,
Nazari SS. Analysis of mortality rate of road traffic
accidents and its trend in 11 years in Iran. Archives
of Trauma Research¦ Volume. 2019 Jan;8(1).
6. Ashford RU, Nichols JS, Mangwani J. Annotation: The
COVID-19 pandemic and clinical orthopaedic and
trauma surgery. Journal of Clinical Orthopaedics &
Trauma. 2020 Apr 2.
7. Abolghasemian M, Ebrahimzadeh MH, Enayatollahi
M, et al. Iranian Orthopedic Association (IOA)
Response Guidance to COVID-19 Pandemic April
2020. Arch Bone Jt Surg. 2020; 8 (Supplement 1):
209-217.
8. Mahdavi A, Khalili N, Davarpanah AH, Faghihi T,
Mahdavi A, Haseli S, Sabri A, Kahkouee S, Kazemi
MA, Mehrian P, Falahati F. Radiologic management
of COVID-19: preliminary experience of the Iranian
Society of Radiology COVID-19 Consultant Group
(ISRCC). Iranian Journal of Radiology. 2020(In 
Press).
9. Mi B, Chen L, Xiong Y, Xue H, Zhou W, Liu G.
Characteristics and Early Prognosis of COVID-19
Infection in Fracture Patients. JBJS. 2020 Apr 1.
10. Abdi R, Shojaeian R, Hajian S, Sheikh S. Surgical
practice in the shadow of COVID-19 outbreak.
The Archives of Bone and Joint Surgery. 2020 Apr
1;8(Covid-19 Special Issue):0-.9.
11. Chua C, Wisniewski T, Ramos A, Schlepp M, Fildes JJ,
Kuhls DA. Multidisciplinary trauma intensive care
unit checklist: impact on infection rates. Journal of
Trauma Nursing. 2010 Jul 1;17(3):163-6.
12. Xie J, Tong Z, Guan X, Du B, Qiu H, Slutsky AS. Critical
care crisis and some recommendations during
the COVID-19 epidemic in China. Intensive care
medicine. 2020 Mar 2:1-4.
13. Khak M, Manafi-Rasi A, Oryadi Zanjani L, et
al. Orthopedic Trauma Surgeries in COVID-19
Pandemic; A Trauma Management Algorithm. Arch
Bone Jt Surg. 2020; 8 (Supplement 1): 286-290.
14. Kalantar SH, Farhoud AR, Mortazavi SMJ. Lockdown
of an Orthopedic Department During COVID-19
Epidemics, Our Experience in a General Hospital.
Arch Bone Jt Surg. 2020; 8 (Supplement 1): 235-241.
15. Vallier HA, Wang X, Moore TA, Wilber JH, Como JJ.
Timing of orthopaedic surgery in multiple trauma
patients: development of a protocol for early
appropriate care. Journal of orthopaedic trauma.
2013 Oct 1;27(10):543-51.
16. Chehrassan M, Ebrahimpour A, Ghandhari H, et
al. Management of Spine Trauma in COVID-19
Pandemic: A Preliminary Report. Arch Bone Jt Surg.
2020; 8 (Supplement 1): 270-276.
The Archives of Bone and Joint Surgery
Volume 8, Issue 3
May 2020
Pages 378-382

Files

History

  • Receive Date: 15 April 2020
  • Revise Date: 26 April 2020
  • Accept Date: 28 April 2020

Share

How to cite

Statistics