J Hand Microsurg 2020; 12(03): 135-162
DOI: 10.1055/s-0040-1713964
Review Article

Perspectives and Consensus among International Orthopaedic Surgeons during Initial and Mid-lockdown Phases of Coronavirus Disease

J. Terrence Jose Jerome
1   Department of Orthopedics, Hand and Reconstructive Microsurgery, Olympia Hospital and Research Centre, Tamil Nadu, India
,
Francisco Mercier
2   Cl ínica Lambert Rua, Cordeiro Ferreira, Lisbon, Portugal
,
Chaitanya S. Mudgal
3   Harvard Medical School, Massachusetts, United States; Hand Surgery Services, Massachusetts General Hospital, Boston, Massachusetts, United States
4   Hand Surgery Service, Massachusetts General Hospital, Boston, Massachusetts, United States
,
Joan Arenas-Prat
5   Department of Orthopaedics, ServeisMedics Penedes, Barcelona, Catalonia, Spain
,
Gustavo Vinagre
6   Department of Orthopaedic Surgery, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
,
Chul Ki Goorens
7   Department of Orthopaedics, Regional Hospital Tienen, Tienen, Belgium
,
Ignacio J. Rivera-Chavarría
8   Servicio Vascular Periférico, Hospital Rafael Ángel Calderón Guardia, San José, Costa Rica
,
Sreedharan Sechachalam
9   11 Jalan Tan Tock Seng, Singapore
,
Bolaji Mofikoya
10   Department of Surgery, College of Medicine, University of Lagos, Lagos, Nigeria
,
Achilleas Thoma
11   Dep artment of Orthopaedics, Hamilton, Ontario, Canada
,
Claudia Medina
12   Department of Orthopaedics, Calle, Colombia
,
IlavarasuTamilmani,
Ignacio J. Rivera-Chavarría
14   Servicio Vascular Periférico, Hospital Rafael Ángel Calderón Guardia, San José, Costa Rica
,
Mark Henry
15   Houston, Texas, United States
,
Ahmadreza Afshar
16   Department of Orthopedics, Imam Khomeini hospital, Urmia University of Medical Sciences, Urmia, Iran
,
Zoe H. Dailiana
17   Department of Orthopaedic Surgery, Faculty of Medicine, University of Thessaly, Larissa, Greece
,
Theddeus O.H. Prasetyono
18   Department of Surgery, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
,
Stefano Artiaco
19   Orthopaedic and Trauma Center, CTO, Turin, Italy
,
Thayur R Madhusudhan
20   Glan Clwyd Hospital, Bodelwyddan, North wales, United Kingdom
,
Skender Ukaj
21   Veternik, Prishtine, Republic of Kosovo
,
Ole Reigstad
22   Hand Surgery Unit, Oslo University Hospital, Oslo, Norway
,
Yoshitaka Hamada
23   Hand Surgery Unit, Kansai Medical University Medical Center, Moriguchi City, Osaka, Japan
,
Rajesh Bedi
24   Fourth Avenue De nistone, Australia
,
Andrea Poggetti
25   Hand and Reconstructive Microsurgery Unit, AOU Careggi, Florence, Italy
,
Mohammad Manna Al-Qattan
26   Riyadh, Saudi Arabia
,
Mahdi Siala
27   Service d’Orthopedie, chu de purpan, Toulouse, France
,
Anand Viswanathan
28   United Kingdom
,
Rafael Romero-Reveron
29   Trauma and Orthopaedic Departamento, Centro Médico Docente La Trinidad, Caracas, Venezuela
,
Joon Pio Hong
30   Hand and Reconstructive Microsurgery Unit, Asan Medical Center, Songpagu Seoul, Korea
,
Kamarul Ariffin Khalid
31   Department of Orthopedics, IIUM Medical Centre, Jalan Sultan Ahmad Shah, Kuantan, Pahang, Malaysia
,
Shivashankar Bhaskaran
32   Iyer Orthopaedic Centre, Solapur, Maharashtra, India
,
Krishnamoorthy Venkatadass
33   Department of Pediatric Orthopaedics, India
,
Somsak Leechavengvongs
34   Department of Orthopaedics, Vichaiyut Hospital, Bangkok, Thailand
,
Chul Ki Goorens
35   School of Medicine, China Medical University, Taichung, Taiwan
,
Sifi Nazim
37   Department of Orthopaedics, Algiers Faculty of Medicine, Algiers, Algeria
,
Alexandru Valentin Georgescu
38   Clinical Hospital for Rehabilitation, University of Medicine Iuliu Hatieganu, Cluj Napoca, Cluj-Napoca, Romania
,
Mathias Tremp
39   Department of Orthopaedics, Dorfplatz 1, Cham, Switzerland
,
Kiran K. Nakarmi
40   Kirtipur Hospital, Kathmandu, Nepal
,
Mohamed A. Ellabban
41   Plastic and Reconstructive Surgery Unit, Department of Surgery, Faculty of Medicine, Suez Canal University, Egypt
,
Pingtak Chan
42   Department of Orthopaedics and Traumatology, Tuen Mun Hospital, Tuen Mun, Hong Kong
,
Andrey Aristov
43   Department of Orthopaedics, Krasnodar, Russia
,
Sandeep Patel
44   Hamilton, New Zealand
,
Constanza L. Moreno-Serrano
45   Bogota, Colombia
,
Shwetabh Rai
46   Madhaw Market Lanka, Uttar Pradesh, India
,
Rishi Mugesh Kanna
47   Coimbatore, India
,
Vijay A Malshikare
48   18.52 North Hand and Wrist Hospital, Pune, Maharashtra, India
,
Katsuhisa Tanabe
49   Department of Orthopaedics, Nishinomiya Municipal Central Hospital, Hayashidacho, Nishinomiya, Japan
,
Simon Thomas
50   Department of Ort hopaedics, Rohini, Delhi, India
,
Kemal Gokkus
51   Alanya Research and Practice Center, Baskent University School of Medicine, Saray Mah, Antalya, Turkey
,
Seung-Hoon Baek
52   Department of Orthopedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
,
Jerker Brandt
53   HandCenter, Öresund, Baltzarsgatan Malmö, Sweden
,
Yin Rith
54   Department of Orthopaedics, Cambodia
,
Alfredo Olazabal
55   Department of Orthopaedics, CABA, Buenos Aires, Argentina
,
Muhammad Saaiq
56   Department of Hand Surgery, National Institute of Rehabilitation Medicine (NIRM), Islamabad, Pakistan
,
Vijay Patil
57   Orthopedics, Hand and Microsurgery Unit, Basildon Unive rsity Hospital, Basildon, Essex, United Kingdom
,
N Jithendran
58   Bommanhalli, Bangalore, Karnataka, India
,
Harshil Parekh
59   Orthopaedic Speciality Hospital, Rajkot, Gujarat, India
,
Yoshitaka Minamikawa
60   Hand Unit, Namba Hand Centre, Osaka, Japan
,
Abdulljawad Almabrouk Atagawi
61   GhotAlshaal, Tripoli, Libya
,
Jalal Ahmed Hadi
62   Department of Orthopaedics, Amman, Jordan
,
Claudia Arroyo Berezowsky
63   Av. Vasco De Quiroga, México
,
Joaquin Moya-Angeler
64   Department of Orthopaedics, Murcia, Spain
,
Marco Antonio Altamirano-Cruz
65   Department of Orthopaedics, Mexico, Spain
,
Luz Adriana Galvis R
66   Bogota, Santa Barbara, Mexico
,
Alex Antezana
67   Calle Tomasbfrias, Boliva
,
Lukasz Paczesny
68   Orvit Clinic, Citomed Healthcare Center, Sklodowskiej, Torun, Poland
,
Carlos Henrique Fernandes
69   Avenida Le oncio de Magalhaes, Sao Paulo, Brazil
,
Md. Asadullah
70   Orthopedics and Hand surgery Unit, Eman Medical College Hospital, Savar, Dhaka, Bangladesh
,
Lo Yuan-Shun
71   Taiwan, China
,
Biser Makelov
72   Department of Orthopaedics, Stara Zagora, Bulgaria
,
Chaitanya Dodakundi
73   Department of Orthopaedics, Rashid Hospital, Dubai, United Arab Emirates
,
Rabindra Regmi
74   Department of Orthopedics and Reconstructive Microsurgery, National Trauma Centre, Kathmandu, Nepal
,
Ganarlo Urquizo Pereira
75   Urbcapillune s/n San Francisco Moquegua, Peru
,
Shuwei Zhang
76   Department of Spine and Bone Tumor Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
,
Binoy Sayoojianadhan
77   Hand and Reconstructive Microsurgery Unit, Department of Orthopedic Surgery, St James Hospital, Chalakudy, Kerala, India
,
Ivan Callupe
78   Avenida Sanchez Carrion, Lima, Peru
,
Mohamed I. Rakha
79   Orthopedic Department, Suez Canal university hospital, Ismailia, Egypt
,
Dino Papes
80   Department of surgery (Ped and Vasc), University Hospital Center Zagreb, Zagreb, Croatia
,
Ramesh Prabu Ganesan
81   Department of Orthopedics, KAP Viswanatham Government Medical College, Trichy, India
,
Mukesh Mohan
82   Trichy, Tamil Nadu, India
,
Arun Jeyaraman
83   2 Chandraganthi Nagar, Bypass Road, Madurai. India
,
Ponnaian Prabhakar
84   Orthopaedics and Joint Replacement Care Hospitals, Nampally Hyderabad, India
,
Arungeethayan Rajniashokan
85   2A Jeyam Paradise, State Bank Officers Colony, Cantonment, Trichy, India
,
I. Geethan
86   Trichy, Tamil Nadu, India
,
Sugavanam Chandrasekar
87   Salem, Tamil Nadu, India
,
Steffen Löw
88   Clinic for Trauma and Hand Surgery, Bad Mergentheim, Germany
,
Kannan Thangavelu
89   Radha Medical Centre, Erode, Tamil Nadu, India
,
Luca Dei Giudici
90   Ortopedia e Traumatologia, Chirurgiaarticolare di Spalla e Ginocchio, Albodei Medici e Chirurghi di Latina, Cagliari, Italy
,
Yuvarajan Palanisamy
91   Ortho One Orthopedic Speciality Hospital, Coimbatore, Tamil Nadu, India
,
Singaravadivelu Vaidyanathan
92   Department of Orthopaedics and Traumatology, Madras Medical College, Chennai, Tamil Nadu, India
,
Jorge Boretto
93   Ciudad Autonoma de Buenos Aires, Argentina
,
Monica Alexandra Ramirez
94   Bucaramanga, Santander, Colombia
,
Thirumalaisamy Subbiah Goundar
95   Department of Orthopedics, Joint Replacement Surgery Unit, KMCH H ospitals, Coimbatore, Tamil Nadu, India
,
Thirumavalavan Kuppusamy
96   Department of Orthopedics, Trauma and Joint Replacement, Shri Bharani Hospital, Villupuram, Tamil Nadu, India
,
Kalaivanan Kanniyan
97   AJRI, SIMS Hospitals No 1, Chennai, Tamil Nadu, India
,
Atul Srivastava
98   Agra, Uttar Pradesh, India
,
Yung-Cheng Chiu
36   Department of Orthopedic Surgery, China Medical University Hospital, Taichung, Taiwan
,
Anil K Bhat
99   Department of Orthopaedics, KMC, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
,
Nalli R Gopinath
100   Department of Orthopedics, Thoothukudi Medical College, India
,
Vijayaraghavan P. Vasudevan
101   Department of Orthopaedics, SRM Medical College, Chennai, Tamil Nadu, India
,
Vineet Abraham
102   Department of Orthopaedics, Mahatma Gandhi Medical College, Pondicherry, India
› Author Affiliations

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.



Publication History

Article published online:
06 July 2020

© 2020. Society of Indian Hand & Microsurgeons. This article is published by Thieme.

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India