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Orthopedics and Coronavirus: Analyzing the Past to Face the Present and to Prevent the Future

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Orthopedics".

Deadline for manuscript submissions: closed (10 October 2022) | Viewed by 14224

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Prof. Dr. Giuseppe Maccagnano

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Orthopedic and Trauma Unit, Department of Clinical and Experimental Medicine, Faculty of Medicine and Surgery, University of Foggia, General Hospital, Foggia, Italy
Interests: orthopedic and trauma surgery; management of trauma complications and bone defects; spine surgery; musculoskeletal system; osteoarthritis; joint replacement; biomechanics aspects of orthopedics
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Prof. Dr. Vito Pesce

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Orthopaedic and Trauma Unit, Department of Clinical and Experimental Medicine, Faculty of Medicine and Surgery, University of Foggia, General Hospital, 76545 Foggia, Italy
Interests: joint replacement orthopedic surgery
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Dear Colleagues,

We find ourselves again collectively in a situation in which we have limited experience and for which we have former preparation. The first wave of the coronavirus pandemic was an unprecedented event that represented the biggest challenge in modern history, creating significant changes in three key areas: outpatient visits (1), inpatient management (2), and surgical treatments (3).

As regards the first point, immediately after the outbreak of the coronavirus disease, outpatients’ visits were limited only to those which were non-deferrable. For example, immediate post-operative follow-up was limited to the first months, and super-specialized services were reduced in order to guarantee the recovery of COVID-19 patients. The time devoted to visits was reduced to minimize contacts. These changes, though crucial at the time, created an environment where patients affected with chronic orthopedic pathologies, such as arthrosis, osteoporosis, and low back pain suffered from a lack of assistance or a great increase in waiting times for therapy.

As regards the second and third point, the growing need for hospital beds led to a reduction in the number of orthopedic hospitalizations and a reduction in the average length of hospitalization. Furthermore, we observed changes in the management and timing of surgery on fragility fractures. For example, if a patient who suffers from a femur fracture exhibits symptoms of COVID-19, it is currently not possible to treat them within 48 hours, as advocated by pre-COVID-19 literature and as would have been the case in pre-COVID-19 times.

This Special Issue will address the above three points, but it also invites studies that perform a stratification of these data according to gender differences in order to propose different treatments.

Prof. Dr. Giuseppe Maccagnano
Prof. Dr. Vito Pesce
Guest Editors

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Keywords

fracture and COVID-19
orthopedic diseases and COVID-19
telemedicine and communication

Published Papers (9 papers)

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Editorial

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2 pages, 182 KiB

Open AccessEditorial

Special Issue—“Orthopedics and Coronavirus: Analyze the Past to Face the Present and to Prevent the Future”

by Giuseppe Maccagnano, Francesco Maruccia, Nicholas Elena and Vito Pesce

J. Clin. Med. 2022, 11(21), 6440; https://doi.org/10.3390/jcm11216440 - 30 Oct 2022

Viewed by 790

Abstract

The coronavirus pandemic represented one of the most massive health emergencies in recent history [...] Full article

(This article belongs to the Special Issue Orthopedics and Coronavirus: Analyzing the Past to Face the Present and to Prevent the Future)

Research

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8 pages, 237 KiB

Open AccessArticle

Increased Frequency of Hand Hygiene and Other Infection Prevention Practices Correlates with Reduced Surgical Wound Infection Rates in Spinal Surgery during the COVID-19 Pandemic

by Andrea Perna, Francesco Maruccia, Franco Lucio Gorgoglione, Felice Barletta, Raffaele Vitiello, Luca Proietti, Francesco Ciro Tamburrelli and Domenico Alessandro Santagada

J. Clin. Med. 2022, 11(24), 7528; https://doi.org/10.3390/jcm11247528 - 19 Dec 2022

Cited by 3 | Viewed by 1631

Abstract

Background: Due to the COVID-19 pandemic outbreak, many changes were done in the hospital practice, and new guidelines were issued in order to contain the infection spread. One of the most common measures is represented by a correct and frequent hand washing. Recently, an association between increased adherence to hand hygiene (HH) protocols and reduction in hospital infections was documented however no studies about the surgical wound infection rate were reported in the Literature. Methods: The present study represents a multicentric retrospective epidemiological study. The HH compliance rate was recorded through direct observations by trained nurses, 24 h a day. The primary outcome was HH compliance rate. The association of HH with spinal surgical wound infections was the secondary outcome. Results: We reported a compliance to HH practices during the pandemic period of 85.2% compared with 57% observed during 2019. Our analysis showed an overall surgical wound infection reduction of 66.6% during the hospital stay in the pandemic period. Conclusion: Hand hygiene has always been considered one of the most effective, reproducible and low-cost weapons to deal with hospital infections. The good health habits acquired during the COVID-19 pandemic should be maintained even after the virus is eradicated. Full article

(This article belongs to the Special Issue Orthopedics and Coronavirus: Analyzing the Past to Face the Present and to Prevent the Future)

8 pages, 219 KiB

Open AccessArticle

Impact of the First and Second Wave of the SARS-CoV-2 Pandemic on Severe Trauma and the Care Structures in the German TraumaNetzwerk DGU^®

by Christian Colcuc, Sebastian Fischer, Philipp Leimkühler, Marco Miersbach, Rolf Lefering, TraumaRegister DGU, Dirk Wähnert, Thomas Vordemvenne and Niklas Grüneweller

J. Clin. Med. 2022, 11(23), 7036; https://doi.org/10.3390/jcm11237036 - 28 Nov 2022

Cited by 1 | Viewed by 1042

Abstract

(1) Background: The aim of this study was to investigate the effects of the pandemic on transfer rates of severely injured patients within the German TraumaNetzwerk of the DGU. Furthermore, cause of accident, rescue times, and trauma cases are compared to pre-pandemic times. (2) Methods: For this investigation patients documented in the TraumaRegister DGU^® from 2018 to 2020 were analyzed. The years 2018 and 2019 served as a comparison to 2020, the first COVID-19 pandemic year. All primary admissions and transfers were included if treated on an intensive care unit. (3) Results: Demographics (age, sex) and injury severity in 2020 were comparable with 2018/2019. In 2020, a significant decrease (3.7%) in car accidents was found. In contrast, a significant increase (3.2%) in bicycle accidents was seen. During the second wave, there was a significant burden of COVID-19 patients on hospitals. In this time, we found a significant increase in early transfers of trauma patients primarily from small level 3 to large level 1 centers. There was also a small but significant increase in rescue time, especially during the 2nd wave. (4) Conclusions: Our data confirm the importance of the network structures established in the TraumaNetzwerk DGU^®, especially during the pandemic. The established structures allow smaller hospitals to spread their resources and prevent internal collapse. Therefore, the structures of the TraumaNetzwerk DGU^® play a prominent role in stabilizing the healthcare system by helping to maintain both surgical and critical care capacity and providing adequate emergency care. Full article

(This article belongs to the Special Issue Orthopedics and Coronavirus: Analyzing the Past to Face the Present and to Prevent the Future)

7 pages, 223 KiB

Open AccessArticle

Second and Third Pandemic Waves in Apulia: How COVID-19 Affected Orthopedic and Trauma Care—A Single-Center Study

by Giovanni Vicenti, Davide Bizzoca, Elisa Pesare, Michele Grasso, Walter Ginestra and Biagio Moretti

J. Clin. Med. 2022, 11(21), 6526; https://doi.org/10.3390/jcm11216526 - 03 Nov 2022

Cited by 3 | Viewed by 1078

Abstract

Purpose: In orthopedics and traumatology, as a direct consequence of the COVID-19 first wave, there was a massive reorganization and a stop to all elective activities, which were postponed. In this study, we aimed to analyze the impact of the COVID-19 pandemic on orthopedic surgery in Apulia during the second wave, from March to June 2021 (when Apulia was under social distancing restrictions), and during the third wave, from September to December 2021 (when Apulia was under no restrictions). We compared these months to the same periods in 2019 for an evaluation of the surgical decrease during the pandemic period. Methods: We performed a retrospective analysis of major orthopedic procedures, day-surgery procedures and urgent procedures (trauma and non-traumatic amputation) performed during the second and third waves of the pandemic in our clinic, and we compared these data with the same procedures performed in the corresponding periods of 2019, before the pandemic. Results: Surgical activity was significantly decreased during both periods; the only increase in surgical activity in 2021 compared to 2019 was in total hip, knee and shoulder arthroplasty, with a surge of +7.69% registered in the period September–December 2021. Conclusions: Longer waiting lists and limited healthcare resources were the big challenges for the orthopedic community, and they still represent a substantial issue to confront today. Full article

(This article belongs to the Special Issue Orthopedics and Coronavirus: Analyzing the Past to Face the Present and to Prevent the Future)

15 pages, 1136 KiB

Open AccessArticle

Direct Anterior versus Lateral Approach for Femoral Neck Fracture: Role in COVID-19 Disease

by Giuseppe Maccagnano, Francesco Maruccia, Michela Rauseo, Giovanni Noia, Michele Coviello, Andrea Laneve, Alessandro Pio Quitadamo, Giacomo Trivellin, Michele Malavolta and Vito Pesce

J. Clin. Med. 2022, 11(16), 4785; https://doi.org/10.3390/jcm11164785 - 16 Aug 2022

Cited by 7 | Viewed by 1559

Abstract

Background: During the COVID-19 emergency, the incidence of fragility fractures in elderly patients remained unchanged. The management of these patients requires a multidisciplinary approach. The study aimed to assess the best surgical approach to treat COVID-19 patients with femoral neck fracture undergoing hemiarthroplasty (HA), comparing direct lateral (DL) versus direct anterior approach (DAA). Methods: A single-center, observational retrospective study including 50 patients affected by COVID-19 infection (30 males, 20 females) who underwent HA between April 2020 to April 2021 was performed. The patients were allocated into two groups according to the surgical approach used: lateral approach and anterior approach. For each patient, the data were recorded: age, sex, BMI, comorbidity, oxygen saturation (SpO₂), fraction of the inspired oxygen (FiO₂), type of ventilation invasive or non-invasive, HHb, P/F ratio (PaO₂/FiO₂), hemoglobin level the day of surgery and 1 day post operative, surgical time, Nottingham Hip Fractures Score (NHFS) and American Society of Anesthesiologists Score (ASA). The patients were observed from one hour before surgery until 48 h post-surgery of follow-up. The patients were stratified into five groups according to Alhazzani scores. A non-COVID-19 group of patients, as the control, was finally introduced. Results: A lateral position led to a better level of oxygenation (p < 0.01), compared to the supine anterior approach. We observed a better post-operative P/F ratio and a reduced need for invasive ventilation in patients lying in the lateral position. A statistically significant reduction in the surgical time emerged in patients treated with DAA (p < 0.01). Patients within the DAA group had a significantly lower blood loss compared to direct lateral approach. Conclusions: DL approach with lateral decubitus seems to preserved respiratory function in HA surgery. Thus, the lateral position may be associated with beneficial effects on gas exchange. Full article

(This article belongs to the Special Issue Orthopedics and Coronavirus: Analyzing the Past to Face the Present and to Prevent the Future)

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8 pages, 647 KiB

Open AccessArticle

One Year of COVID-19: Lessons Learned in a Hand Trauma Center

by Marcello Covino, Camillo Fulchignoni, Silvia Pietramala, Marco Barbaliscia, Francesco Franceschi, Giulio Maccauro, Gianfranco Merendi and Lorenzo Rocchi

J. Clin. Med. 2022, 11(8), 2163; https://doi.org/10.3390/jcm11082163 - 13 Apr 2022

Cited by 4 | Viewed by 1215

Abstract

2020 will be remembered worldwide as the year of COVID-19 outbreak. The onset of this pandemic abruptly changed everybody’s life and, in a particular manner, doctors’ lives. Our hand surgery department became rapidly one of the first COVID-19-specialized wards in Italy, impacting considerably the authors’ routines and activities. In this paper, the authors focus on how the demographics of patients with hand trauma changed and how they had to modify their activity. The authors retrospectively took into consideration all patients reaching their emergency department (ED) with hand trauma between 9 March 2020 (the day of the beginning of the first lockdown in Italy) and 8 March 2021 and compared them to those who reached the ED in the three previous years. Authors have analyzed the number of patients, their gender and age, the severity of their trauma, where the trauma occurred, the type of lesion, the percentage of patients who underwent surgery, and the percentage of patients who had an emergency admission. In the last year, the number of patients reaching the ED for a hand trauma has been reduced by two thirds (975 patients during the past year), the mean age of those patients has slightly increased, the severity of cases has increased, places of trauma and type of lesions have changed, and, lastly, the percentage of patients needing surgery who were admitted immediately has increased. This paper shows how the type of patients reaching the ED changed and discusses how surgeons evolved and modified their habits in treating those patients during the first lockdown and the year that followed. Full article

(This article belongs to the Special Issue Orthopedics and Coronavirus: Analyzing the Past to Face the Present and to Prevent the Future)

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7 pages, 717 KiB

Open AccessArticle

Reduction in the Duration of Postoperative Fever during the COVID-19 Pandemic in Orthopedic and Traumatic Surgery Due to PPE and Cautions

by Pierluigi Mastri, Francesco Di Petrillo, Alessandro Cerone, Mario Muselli, Michela Saracco, Giandomenico Logroscino and Vittorio Calvisi

J. Clin. Med. 2022, 11(6), 1635; https://doi.org/10.3390/jcm11061635 - 16 Mar 2022

Cited by 3 | Viewed by 2221

Abstract

The Italian government on the 8th of march in response to the increased global prevalenceof severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) stated a national quarantine. In this period the absence of rapid and sure screening tests for COVID-19 made necessary more attention for presence of fever in hospitalized patients, like continuous use of surgical, FFP2, and FFP3 masks (PPE) by nurses, physicians, and patients; moreover, patients visits were restricted. In this period, during the daily activities in our orthopedic department we observed an empirical decreased incidence of post-operative fever in patients admitted for trauma surgery. The aim of this study is to compare the prevalence of post-operative fever in this period with the same period in 2019. We analyzed the presence of post-operative fever in 110 patients admitted in 2020 and 129 admitted in 2019. The results show a significant decrease of the prevalence and duration of post-operative fever in patients admitted in 2020. This study evidenced that the use of PPE and limitation in external access to the hospital decrease postoperative fever in hospitalized patients undergone surgery for fracture. Full article

(This article belongs to the Special Issue Orthopedics and Coronavirus: Analyzing the Past to Face the Present and to Prevent the Future)

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14 pages, 1213 KiB

Open AccessArticle

Impact and Strategies on Joint Surgery Centers without Lockdowns during the Peak of the COVID-19 Pandemic: A Multicenter Cross-Sectional Study

by Chia-Hao Hsu and Nin-Chieh Hsu

J. Clin. Med. 2021, 10(22), 5392; https://doi.org/10.3390/jcm10225392 - 19 Nov 2021

Cited by 5 | Viewed by 1616

Abstract

The real psychological impact of COVID-19 remains difficult to quantify and may differ between hospital sizes and levels. Taiwan’s response to COVID-19 differed in that it successfully prevented its spread, without implementing any lockdowns before May 2021. Patients’ fear would be the major reason for the reduction of surgeries. The daily data for patients who underwent total knee arthroplasty (TKA), total hip arthroplasty, and hemiarthroplasty were collected from two major joint surgery centers of a university hospital and a community hospital in Taiwan. Compared with the previous year, the initial impact of the pandemic evidently reduced the total number of patients (outpatient: 20–29%; admission: 22–37%; surgery: 18–35%) in both hospitals. During the study period, the total number of TKAs decreased by 56–61% in both hospitals. The reduction in arthroplasty surgeries was attributable to patients’ fear. Even with confirmed COVID-19 cases, the university hospital experienced less impact than the community hospital. The TKA was the most affected of all surgery types. Even without local epidemics and restrictions in Taiwan, the worldwide pandemic inevitably led to a reduction of approximately 60% of the total TKA operation volume, especially for community hospitals. The surgery scheduling strategies helped maintain the routine arthroplasty services. Full article

(This article belongs to the Special Issue Orthopedics and Coronavirus: Analyzing the Past to Face the Present and to Prevent the Future)

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Review

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20 pages, 1781 KiB

Open AccessReview

Global Impact of the COVID-19 Pandemic on Orthopedics and the Implications of Telemedicine: A Systematic Review of the Literature

by Chia-Hao Hsu, Hsuan-Ti Huang, Chung-Hwan Chen, Yin-Chih Fu, Pei-Hsi Chou and Nin-Chieh Hsu

J. Clin. Med. 2022, 11(11), 2983; https://doi.org/10.3390/jcm11112983 - 25 May 2022

Cited by 7 | Viewed by 1914

Abstract

This study aimed to systematically review the literature on the impact of the coronavirus disease (COVID-19) pandemic on the orthopedics field by focusing on multiple aspects, including orthopedic training and application, performance, work loading, change of practice, research work, and other psychological factors. Published articles were searched using the PubMed database. Articles were selected in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Of 58 studies published between 1 January 2020 and 1 October 2021, 57 peer-reviewed original articles were included. Nearly 90% of students experienced an impact of the pandemic on application. The impact on training stemmed from redeployment rates of 20.9–23.1%. The rate of emergency or outpatient visits decreased from 18% to 58.6%. The rates of all surgeries or emergency surgeries decreased by 15.6–49.4%, while the rates of elective surgeries decreased by 43.5–100%. The rate of work loading ranged from 33% to 66%. Approximately 50–100% of surgeons had a change of practice. A total of 40.5% of orthopedic surgeons experienced mild psychological pressure. Approximately 64% had stopped research participant recruitment. Most of the included studies were conducted in Europe, followed by Asia and North America. It is suggested orthopedic surgeons prepare more sufficient, flexible, and reservable staffing measures, proper preventive strategies and surgical scheduling algorithms, and set up dedicated venues and equipment for routine telemedicine with staff training for virtual teaching or consultations in case of future impacts on orthopedics. Full article

(This article belongs to the Special Issue Orthopedics and Coronavirus: Analyzing the Past to Face the Present and to Prevent the Future)

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