Surgical Management of Extremity Fractures in COVID-19 Patients
-
Adel Ebrahimpour
,
Mohammadreza Chehrassan
,
Amir Human Hoveidaei
,
Meisam Jafari Kafiabadi
,
Mehrdad Sadighi
,
Alireza Manafi Rasi
,
Morteza Sanei Taheri
,
Alireza Fatemi
,
SM Javad Mortazavi
Abstract
Background: COVID-19 is spreading rapidly and potentially affects every person, including fracture patients. This study was conducted with the aim to evaluate our primary months’ experience of surgical treatment of fractures in COVID-19 infected patients in order to assist in better decision-making in the next waves of the infection.
Methods: In this cross-sectional study, 15 patients with orthopedic trauma and COVID-19 infection were included from 2 trauma centers during February and March 2020.
Results: Most of the patients were younger than 40 year of age. The most common COVID-19 related symptom at presentation was malaise, and a hypoxia rate of 85.7% was detected among the patients. Two-thirds of the fractures were in the lower extremities. One patient expired, but all others were discharged with no follow-up complications.
Conclusion: Surgical management of fractures in COVID-19 patients is inevitable. To achieve this, sensitive screening techniques and standard protection measures are essential.
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26. Bernheim A, Mei X, Huang M, Yang Y, Fayad ZA, Zhang N, et al. Chest CT Findings in Coronavirus Disease-19 (COVID-19): Relationship to Duration of Infection. Radiology. 2020;295(3):200463. doi: 10.1148/radiol.2020200463. [PubMed: 32077789]. [PubMed Central: PMC7233369].
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29. Ministry of Health and Medical Education of Iran. Instructions for Care, Diagnosis, Treatment of New Coronavirus (nCoV-
2019) [Online]. [cited 2019]; Available from: URL: http://treatment.sbmu.ac.ir/uploads/12-2-korona_dastoor_2.pdf
30. Kuloor D, Shareef D. Internal fixation of low energy pilon fractures: Prospective study of two treatment options (ORIF/MIPO). Int J Orthop Sci. 2019;5(2):769-73. doi: 10.22271/ortho.2019.v5.i2k.87.
31. Duncan CM, Long KH, Warner DO, Pagnano MW, Hebl JR. The
Economic Implications of a Multimodal Analgesic Regimen Combined with Minimally Invasive Orthopedic Surgery: A Comparative Cost Study. J Anesthe Clinic Res. 2010;1:101 doi: 10.4172/2155-6148.1000101.
32. Lie SA, Wong SW, Wong LT, Wong TGL, Chong SY. Practical considerations for performing regional anesthesia: lessons learned from the COVID-19 pandemic. Can J Anaesth. 2020;67(7):885-92. doi: 10.1007/s12630-020-01637-0. [PubMed: 32212103]. [PubMed Central: PMC7095295].
33. Farpour HR, Hoveidaei AH, Habibi L, Moosavi M, Farpour S. The impact of social media use on depression in multiple sclerosis patients. Acta Neurol Belg. 2020;120(6):1405-9. doi: 10.1007/s13760-020-01407-1. [PubMed: 32566990]. [PubMed Central: PMC7306188].
2. 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 Med. 2020;46(5):837-40. doi: 10.1007/s00134-020-05979-7. [PubMed: 32123994].
3. Gona CV. Letter to the editor: Cancellation of elective surgery during the COVID-19 pandemic. East Cent Afr j surg 2020;25(1):7. doi: 10.4314/ecajs.v25i1.7.
4. Abolghasemian M, Ebrahimzadeh MH, Enayatollahi M, Honarmand K, Kachooei AR, Mehdipoor S, et al. Iranian Orthopedic Association (IOA) Response Guidance to COVID-19 Pandemic April 2020. Arch Bone Jt Surg. 2020;8(Suppl 1):209-17. doi: 10.22038/ABJS.2020.47678.2370. [PubMed: 32733977]. [PubMed Central: PMC7296590].
5. Chang LZ, Wang W, Murphy D, Po Hui JH. Novel coronavirus and orthopaedic surgery: Early experiences from singapore. J Bone Joint Surg Am. 2020;102(9):745-9. doi: 10.2106/JBJS.20.00236. [PubMed: 32379113]. [PubMed Central: PMC7141583].
6. 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;67(6):732-45. doi: 10.1007/s12630-020-01620-9. [PubMed: 32162212]. [PubMed Central: PMC7090449].
7. Kolifarhood G, Aghaali M, Mozafar SH, Taherpour N, Rahimi S, Izadi N, et al. Epidemiological and Clinical Aspects of COVID-19; a Narrative Review. Arch Acad Emerg Med. 2020;8(1):e41. doi:
10.22037/aaem.v8i1.620. [PubMed: 32259130]. [PubMed Central: PMC7117787].
8. Mi B, Chen L, Xiong Y, Xue H, Zhou W, Liu G. Characteristics and early prognosis of covid-19 infection in fracture patients. J Bone Joint Surg Am. 2020;102(9):750-8. doi: 10.2106/JBJS.20.00390. [PubMed: 32379114]. [PubMed Central: PMC7219849].
9. Farrell S, Schaeffer EK, Mulpuri K. Recommendations for the care of pediatric orthopaedic patients during the COVID-19 pandemic. J Am Acad Orthop Surg. 2020;28(11):e477-e486. doi: 10.5435/JAAOS-D-20-00391. [PubMed: 32301817]. [PubMed Central: PMC7197339].
10. Catellani F, Coscione A, D'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. [PubMed: 32345864]. [PubMed Central: PMC7224593].
11. Ghanbari B. On forecasting the spread of the COVID-19 in Iran: The second wave. Chaos Solitons Fractals. 2020;140:110176. doi: 10.1016/j.chaos.2020.11017. [PubMed: 32834656]. [PubMed Central: PMC7386426].
12. Venkatesan P. COVID-19 in Iran: round 2. Lancet Infect Dis.
2020;20(7):784. doi: 10.1016/S1473-3099(20)30500-4. [PubMed:
32592672]. [PubMed Central: PMC7314444].
13. Xu S, Li Y. Beware of the second wave of COVID-19. Lancet. 2020;395(10233):1321-2. doi: 10.1016/S0140-6736(20)30845-X. [PubMed: 32277876]. [PubMed Central: PMC7194658].
14. Wise J. Covid-19: Risk of second wave is very real, say
researchers. BMJ. 2020;369:m2294. doi: 10.1136/bmj.m2294.
[PubMed: 32518177].
15. Ferrante L, Steinmetz WA, Almeida ACL, Leao J, Vassao RC, Tupinambas U, et al. Brazil's policies condemn Amazonia to a second wave of COVID-19. Nat Med. 2020;26(9):1315. doi: 10.1038/s41591-020-1026-x. [PubMed: 32770168].
16. Mehrpour SR, Nabian MH, Oryadi ZL, Foroughmand-Araabi MH, Shahryar KR. Descriptive epidemiology of traumatic injuries in 18890 adults: A 5-year-study in a tertiary trauma center in iran. Asian J Sports Med. 2015;6(1):e23129. doi:
10.5812/asjsm.23129. [PubMed: 25883772]. [PubMed Central: PMC4393542].
17. Guillamondegui OD, Richards JE, Ely EW, Jackson JC, Archer KR, Norris PR, et al. Does hypoxia affect intensive care unit delirium or long-term cognitive impairment after multiple trauma without intracranial hemorrhage? J Trauma. 2011;70(4):910-5.
doi: 10.1097/TA.0b013e3182114f18. [PubMed: 21610396].
18. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506. doi: 10.1016/S0140-6736(20)30183-5. [PubMed: 31986264]. [PubMed Central: PMC7159299].
19. Adhikari SP, Meng S, Wu YJ, Mao YP, Ye RX, Wang QZ, et al. Epidemiology, causes, clinical manifestation and diagnosis, prevention and control of coronavirus disease (COVID-19) during the early outbreak period: A scoping review. Infect Dis Poverty. 2020;9(1):29. doi: 10.1186/s40249-020-00646-x. [PubMed: 32183901]. [PubMed Central: PMC7079521].
20. Lan L, Xu D, Ye G, Xia C, Wang S, Li Y, et al. Positive RT-PCR test results in patients recovered from COVID-19. JAMA. 2020;323(15):1502-3. doi: 10.1001/jama.2020.2783. [PubMed: 32105304]. [PubMed Central: PMC7047852].
21. Deng Y, Lei L, Chen Y, Zhang W. The potential added value of FDG PET/CT for COVID-19 pneumonia. Eur J Nucl Med Mol Imaging. 2020;47(7):1634-5. doi: 10.1007/s00259-020-04767-1. [PubMed: 32198615]. [PubMed Central: PMC7087529].
22. Fang Y, Zhang H, Xie J, Lin M, Ying L, Pang P, et al. Sensitivity of chest CT for COVID-19: Comparison to RT-PCR. Radiology. 2020;296(2):E115-E117. doi: 10.1148/radiol.2020200432. [PubMed: 32073353]. [PubMed Central: PMC7233365].
23. Li Y, Xia L. Coronavirus Disease 2019 (COVID-19): Role of chest CT in diagnosis and management. AJR Am J Roentgenol. 2020;214(6):1280-6. doi: 10.2214/AJR.20.22954. [PubMed: 32130038].
24. Wang S, Kang B, Ma J, Zeng X, Xiao M, Guo J, et al. A deep learning algorithm using CT images to screen for Corona virus disease (COVID-19). Eur Radiol. 2021;31(8):6096-104. doi: 10.1007/s00330-021-07715-1. [PubMed: 33629156]. [PubMed Central: PMC7904034].
25. Ai T, Yang Z, Hou H, Zhan C, Chen C, Lv W, et al. Correlation of chest CT and RT-PCR testing for coronavirus disease 2019 (COVID-19) in China: A report of 1014 cases. Radiology. 2020;296(2):E32-E40. doi: 10.1148/radiol.2020200642. [PubMed: 32101510]. [PubMed Central: PMC7233399].
26. Bernheim A, Mei X, Huang M, Yang Y, Fayad ZA, Zhang N, et al. Chest CT Findings in Coronavirus Disease-19 (COVID-19): Relationship to Duration of Infection. Radiology. 2020;295(3):200463. doi: 10.1148/radiol.2020200463. [PubMed: 32077789]. [PubMed Central: PMC7233369].
27. 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;296(2):E15-E25. doi: 10.1148/radiol.2020200490. [PubMed: 32083985]. [PubMed Central: PMC7233368].
28. Mahdavi A, Khalili N, Davarpanah AH, Faghihi T, Mahdavi A, Haseli S, et al. Radiologic management of COVID-19: Preliminary experience of the Iranian Society of Radiology COVID-19 Consultant Group (ISRCC). Iran J Radiol. 2020;17(2):e102324. doi: 10.5812/iranjradiol.102324
29. Ministry of Health and Medical Education of Iran. Instructions for Care, Diagnosis, Treatment of New Coronavirus (nCoV-
2019) [Online]. [cited 2019]; Available from: URL: http://treatment.sbmu.ac.ir/uploads/12-2-korona_dastoor_2.pdf
30. Kuloor D, Shareef D. Internal fixation of low energy pilon fractures: Prospective study of two treatment options (ORIF/MIPO). Int J Orthop Sci. 2019;5(2):769-73. doi: 10.22271/ortho.2019.v5.i2k.87.
31. Duncan CM, Long KH, Warner DO, Pagnano MW, Hebl JR. The
Economic Implications of a Multimodal Analgesic Regimen Combined with Minimally Invasive Orthopedic Surgery: A Comparative Cost Study. J Anesthe Clinic Res. 2010;1:101 doi: 10.4172/2155-6148.1000101.
32. Lie SA, Wong SW, Wong LT, Wong TGL, Chong SY. Practical considerations for performing regional anesthesia: lessons learned from the COVID-19 pandemic. Can J Anaesth. 2020;67(7):885-92. doi: 10.1007/s12630-020-01637-0. [PubMed: 32212103]. [PubMed Central: PMC7095295].
33. Farpour HR, Hoveidaei AH, Habibi L, Moosavi M, Farpour S. The impact of social media use on depression in multiple sclerosis patients. Acta Neurol Belg. 2020;120(6):1405-9. doi: 10.1007/s13760-020-01407-1. [PubMed: 32566990]. [PubMed Central: PMC7306188].
| Files | ||
| Issue | Vol 7, No 4 (2021) | |
| Section | Research Articles | |
| DOI | https://doi.org/10.18502/jost.v7i4.8858 | |
| Keywords | ||
| Bone; COVID-19; Fractures; Orthopedics; Personal Protective Equipment | ||
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How to Cite
1.
Ebrahimpour A, Chehrassan M, Hoveidaei AH, Jafari Kafiabadi M, Sadighi M, Manafi Rasi A, Sanei Taheri M, Fatemi A, Mortazavi SJ. Surgical Management of Extremity Fractures in COVID-19 Patients. J Orthop Spine Trauma. 2022;7(4):127-133.
