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Jerome JTJ, Mercier F, Mudgal CS, Arenas-Prat J, Vinagre G, Goorens CK, Rivera-Chavarría IJ, Sechachalam S, Mofikoya B, Thoma A, Medina C, Rivera-Chavarría IJ, Henry M, Afshar A, Dailiana ZH, Prasetyono TOH, Artiaco S, Madhusudhan TR, Ukaj S, Reigstad O, Hamada Y, Bedi R, Poggetti A, Al-Qattan MM, Siala M, Viswanathan A, Romero-Reveron R, Hong JP, Khalid KA, Bhaskaran S, Venkatadass K, Leechavengvongs S, Goorens CK, Nazim S, Georgescu AV, Tremp M, Nakarmi KK, Ellabban MA, Chan P, Aristov A, Patel S, Moreno-Serrano CL, Rai S, Kanna RM, Malshikare VA, Tanabe K, Thomas S, Gokkus K, Baek SH, Brandt J, Rith Y, Olazabal A, Saaiq M, Patil V, Jithendran N, Parekh H, Minamikawa Y, Atagawi AA, Hadi JA, Berezowsky CA, Moya-Angeler J, Altamirano-Cruz MA, Galvis R LA, Antezana A, Paczesny L, Fernandes CH, Asadullah M, Yuan-Shun L, Makelov B, Dodakundi C, Regmi R, Pereira GU, Zhang S, Sayoojianadhan B, Callupe I, Rakha MI, Papes D, Ganesan RP, Mohan M, Jeyaraman A, Prabhakar P, Rajniashokan A, Geethan I, Chandrasekar S, Löw S, Thangavelu K, Giudici LD, Palanisamy Y, Vaidyanathan S, Boretto J, Ramirez MA, Goundar TS, Kuppusamy T, Kanniyan K, Srivastava A, Chiu YC, Bhat AK, Gopinath NR, Vasudevan VP, Abraham V. Perspectives and Consensus among International Orthopaedic Surgeons during Initial and Mid-lockdown Phases of Coronavirus Disease. J Hand Microsurg 2020; 12:135-162. [PMID: 33408440 DOI: 10.1055/s-0040-1713964] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
With a lot of uncertainty, unclear, and frequently changing management protocols, COVID-19 has significantly impacted the orthopaedic surgical practice during this pandemic crisis. Surgeons around the world needed closed introspection, contemplation, and prospective consensual recommendations for safe surgical practice and prevention of viral contamination. One hundred orthopaedic surgeons from 50 countries were sent a Google online form with a questionnaire explicating protocols for admission, surgeries, discharge, follow-up, relevant information affecting their surgical practices, difficulties faced, and many more important issues that happened during and after the lockdown. Ten surgeons critically construed and interpreted the data to form rationale guidelines and recommendations. Of the total, hand and microsurgery surgeons (52%), trauma surgeons (32%), joint replacement surgeons (20%), and arthroscopy surgeons (14%) actively participated in the survey. Surgeons from national public health care/government college hospitals (44%) and private/semiprivate practitioners (54%) were involved in the study. Countries had lockdown started as early as January 3, 2020 with the implementation of partial or complete lifting of lockdown in few countries while writing this article. Surgeons (58%) did not stop their surgical practice or clinics but preferred only emergency cases during the lockdown. Most of the surgeons (49%) had three-fourths reduction in their total patients turn-up and the remaining cases were managed by conservative (54%) methods. There was a 50 to 75% reduction in the number of surgeries. Surgeons did perform emergency procedures without COVID-19 tests but preferred reverse transcription polymerase chain reaction (RT-PCR; 77%) and computed tomography (CT) scan chest (12%) tests for all elective surgical cases. Open fracture and emergency procedures (60%) and distal radius (55%) fractures were the most commonly performed surgeries. Surgeons preferred full personal protection equipment kits (69%) with a respirator (N95/FFP3), but in the case of unavailability, they used surgical masks and normal gowns. Regional/local anesthesia (70%) remained their choice for surgery to prevent the aerosolized risk of contaminations. Essential surgical follow-up with limited persons and visits was encouraged by 70% of the surgeons, whereas teleconsultation and telerehabilitation by 30% of the surgeons. Despite the protective equipment, one-third of the surgeons were afraid of getting infected and 56% feared of infecting their near and dear ones. Orthopaedic surgeons in private practice did face 50 to 75% financial loss and have to furlough 25% staff and 50% paramedical persons. Orthopaedics meetings were cancelled, and virtual meetings have become the preferred mode of sharing the knowledge and experiences avoiding human contacts. Staying at home, reading, and writing manuscripts became more interesting and an interesting lifestyle change is seen among the surgeons. Unanimously and without any doubt all accepted the fact that COVID-19 pandemic has reached an unprecedented level where personal hygiene, hand washing, social distancing, and safe surgical practices are the viable antidotes, and they have all slowly integrated these practices into their lives. Strict adherence to local authority recommendations and guidelines, uniform and standardized norms for admission, inpatient, and discharge, mandatory RT-PCR tests before surgery and in selective cases with CT scan chest, optimizing and regularizing the surgeries, avoiding and delaying nonemergency surgeries and follow-up protocols, use of teleconsultations cautiously, and working in close association with the World Health Organization and national health care systems will provide a conducive and safe working environment for orthopaedic surgeons and their fraternity and also will prevent the resurgence of COVID-19.
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Affiliation(s)
- J Terrence Jose Jerome
- Department of Orthopedics, Hand and Reconstructive Microsurgery, Olympia Hospital and Research Centre, Tamil Nadu, India
| | | | - Chaitanya S Mudgal
- Harvard Medical School, Massachusetts, United States; Hand Surgery Services, Massachusetts General Hospital, Boston, Massachusetts, United States.,Hand Surgery Service, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Joan Arenas-Prat
- Department of Orthopaedics, ServeisMedics Penedes, Barcelona, Catalonia, Spain
| | - Gustavo Vinagre
- Department of Orthopaedic Surgery, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Chul Ki Goorens
- Department of Orthopaedics, Regional Hospital Tienen, Tienen, Belgium
| | | | | | - Bolaji Mofikoya
- Department of Surgery, College of Medicine, University of Lagos, Lagos, Nigeria
| | | | | | | | | | | | - Ahmadreza Afshar
- Department of Orthopedics, Imam Khomeini hospital, Urmia University of Medical Sciences, Urmia, Iran
| | - Zoe H Dailiana
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Theddeus O H Prasetyono
- Department of Surgery, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | | | | | | | - Ole Reigstad
- Hand Surgery Unit, Oslo University Hospital, Oslo, Norway
| | - Yoshitaka Hamada
- Hand Surgery Unit, Kansai Medical University Medical Center, Moriguchi City, Osaka, Japan
| | | | - Andrea Poggetti
- Hand and Reconstructive Microsurgery Unit, AOU Careggi, Florence, Italy
| | | | - Mahdi Siala
- Service d'Orthopedie, chu de purpan, Toulouse, France
| | | | - Rafael Romero-Reveron
- Trauma and Orthopaedic Departamento, Centro Médico Docente La Trinidad, Caracas, Venezuela
| | - Joon Pio Hong
- Hand and Reconstructive Microsurgery Unit, Asan Medical Center, Songpagu Seoul, Korea
| | - Kamarul Ariffin Khalid
- Department of Orthopedics, IIUM Medical Centre, Jalan Sultan Ahmad Shah, Kuantan, Pahang, Malaysia
| | | | | | | | - Chul Ki Goorens
- School of Medicine, China Medical University, Taichung, Taiwan
| | - Sifi Nazim
- Department of Orthopaedics, Algiers Faculty of Medicine, Algiers, Algeria
| | | | - Mathias Tremp
- Department of Orthopaedics, Dorfplatz 1, Cham, Switzerland
| | | | - Mohamed A Ellabban
- Plastic and Reconstructive Surgery Unit, Department of Surgery, Faculty of Medicine, Suez Canal University, Egypt
| | - Pingtak Chan
- Department of Orthopaedics and Traumatology, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | | | | | | | | | | | | | - Katsuhisa Tanabe
- Department of Orthopaedics, Nishinomiya Municipal Central Hospital, Hayashidacho, Nishinomiya, Japan
| | - Simon Thomas
- Department of Ort hopaedics, Rohini, Delhi, India
| | - Kemal Gokkus
- Alanya Research and Practice Center, Baskent University School of Medicine, Saray Mah, Antalya, Turkey
| | - Seung-Hoon Baek
- Department of Orthopedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
| | | | - Yin Rith
- Department of Orthopaedics, Cambodia
| | | | - Muhammad Saaiq
- Department of Hand Surgery, National Institute of Rehabilitation Medicine (NIRM), Islamabad, Pakistan
| | - Vijay Patil
- Orthopedics, Hand and Microsurgery Unit, Basildon Unive rsity Hospital, Basildon, Essex, United Kingdom
| | | | | | | | | | | | | | | | | | | | | | - Lukasz Paczesny
- Orvit Clinic, Citomed Healthcare Center, Sklodowskiej, Torun, Poland
| | | | - Md Asadullah
- Orthopedics and Hand surgery Unit, Eman Medical College Hospital, Savar, Dhaka, Bangladesh
| | | | | | | | - Rabindra Regmi
- Department of Orthopedics and Reconstructive Microsurgery, National Trauma Centre, Kathmandu, Nepal
| | | | - Shuwei Zhang
- Department of Spine and Bone Tumor Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Binoy Sayoojianadhan
- Hand and Reconstructive Microsurgery Unit, Department of Orthopedic Surgery, St James Hospital, Chalakudy, Kerala, India
| | | | - Mohamed I Rakha
- Orthopedic Department, Suez Canal university hospital, Ismailia, Egypt
| | - Dino Papes
- Department of surgery (Ped and Vasc), University Hospital Center Zagreb, Zagreb, Croatia
| | - Ramesh Prabu Ganesan
- Department of Orthopedics, KAP Viswanatham Government Medical College, Trichy, India
| | | | | | - Ponnaian Prabhakar
- Orthopaedics and Joint Replacement Care Hospitals, Nampally Hyderabad, India
| | | | | | | | - Steffen Löw
- Clinic for Trauma and Hand Surgery, Bad Mergentheim, Germany
| | | | - Luca Dei Giudici
- Ortopedia e Traumatologia, Chirurgiaarticolare di Spalla e Ginocchio, Albodei Medici e Chirurghi di Latina, Cagliari, Italy
| | | | | | | | | | | | - Thirumavalavan Kuppusamy
- Department of Orthopedics, Trauma and Joint Replacement, Shri Bharani Hospital, Villupuram, Tamil Nadu, India
| | | | | | - Yung-Cheng Chiu
- Department of Orthopedic Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Anil K Bhat
- Department of Orthopaedics, KMC, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | | | | | - Vineet Abraham
- Department of Orthopaedics, Mahatma Gandhi Medical College, Pondicherry, India
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