What have we learnt as orthopaedic surgeons? Pandemic surveillance of surgically treated fracture patients

Year 2025, , 54 - 61, 29.01.2025

Murat Taşcı , Sedat Duman , İhsan Özdamar

https://doi.org/10.21673/anadoluklin.1467004

Abstract

Aim: To investigate the epidemiological and demographic data of the patients operated on during the first wave of the pandemic, and to analyze what the pandemic has taught orthopedic surgeons

Methods: In this retrospective analysis, 90 patients who were operated in our clinic were analyzed. Demographic data, injury mechanism, fracture site, anesthesia type, the number of consultations after admission, the comorbidities, average time between first admission to hospitalization, the length of stay in the intensive care unit (ICU), and neutrophil-lymphocyte ratio (NLR) were investigated.

Results: Higher incidence of hip fractures was observed in COVID-positive patients (p<0.001). The number of two or more consultations requested was significantly higher in COVID-positive patients (p=0.034). As the number of consultations requested increased, the mean time between the first admission and hospitalization also increased (p=0.036). Moreover, there was a significant association between COVID-positivity and the need for ICU follow-up (p=0.001). When the postoperative NLR was compared, it was found to be significantly different in COVID-positive patients compared to COVID-negative patients (p=0.005).

Conclusion: During the heart of disasters, patients with high comorbidity should not be made to wait for long periods in the emergency department. It is important to inform them and their relatives about the prognosis and possible ICU follow-up of these patients. It is important to consider that domestic injuries may increase. Additionally, it is important to note that parameters such as NLR, which are commonly used in routine follow-up, may be affected by infections.

Keywords

COVID-19, hip fracture, infection, intensive care unit

Ethical Statement

This study was approved by Ethics Committee of Ümraniye Training and Research Hospital, Noninvasive Clinic Ethics Committee (Approval date: 12/05/2020; Number:160)

Supporting Institution

Funding: The author(s) received no financial support for the research.

Thanks

None

Ortopedik cerrahlar olarak ne öğrendik? Cerrahi tedavi gören kırık hastalarının pandemik sürveyansı

Abstract

Amaç: Pandeminin ilk dalgası sırasında ameliyat edilen hastaların epidemiyolojik ve demografik verilerini araştırmak ve pandeminin ortopedik cerrahlara neler öğrettiğini analiz etmek

Yöntemler: Bu retrospektif analizde kliniğimizde ameliyat edilen 90 hasta incelendi. Demografik veriler, yaralanma mekanizması, kırık bölgesi, anestezi tipi, başvurudan sonraki konsültasyon sayısı, eşlik eden hastalıklar, ilk başvurudan hastaneye yatışa kadar geçen ortalama süre, yoğun bakım ünitesinde (YBÜ) kalış süresi ve nötrofil-lenfosit oranı (NLO) incelendi.

Bulgular: COVID-pozitif hastalarda daha yüksek kalça kırığı insidansı gözlenmiştir (p<0,001). İstenen iki veya daha fazla konsültasyon sayısı COVID-pozitif hastalarda anlamlı olarak daha yüksekti (p=0,034). İstenen konsültasyon sayısı arttıkça, ilk başvuru ile hastaneye yatış arasındaki ortalama süre de artmıştır (p=0,036). Ayrıca, COVID pozitifliği ile YBÜ takip ihtiyacı arasında anlamlı bir ilişki vardı (p=0,001). Ameliyat sonrası NLR karşılaştırıldığında, COVID-pozitif hastalarda COVID-negatif hastalara kıyasla anlamlı derecede farklı bulunmuştur (p=0,005).

Sonuç: Afetlerin merkezinde, yüksek komorbiditesi olan hastalar acil serviste uzun süre bekletilmemelidir. Bu hastaların prognozu ve olası YBÜ takibi hakkında kendilerini ve yakınlarını bilgilendirmek önemlidir. Ev içi yaralanmaların artabileceğini göz önünde bulundurmak önemlidir. Ayrıca rutin takipte sık kullanılan NLR gibi parametrelerin enfeksiyonlardan etkilenebileceği unutulmamalıdır.

Keywords

COVID-19, enfeksiyon, kalça kırıkları, yoğun bakım ünitesi

References

• Gencer B, Çulcu A, Doğan Ö. COVID-19 exposure and health status of orthopedic residents: A survey study. J Exp Clin Med. 2022;39(2):337-41.
• Rothe C, Schunk M, Sothmann P, et.al. Transmission of 2019-nCoV Infection from an Asymptomatic Contact in Germany. N Engl J Med. 2020;382(10):970-1.
• Gencer B, Doğan Ö. Consequences of the COVID-19 pandemic on fracture distribution: Epidemiological data from a tertiary trauma center in Turkey. J Exp Clin Med. 2022;39(1):128-33.
• 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.
• Chen YC, Lin WC. Risk of long-term infection-related death in clinical osteoporotic vertebral fractures: A hospital-based analysis. PLoS One. 2017;12(8):e0182614.
• Gencer B, Doğan Ö. Analyzing Mid-to-Long Term Mortality Rates and Associated Factors of Geriatric Patients with Hip Fractures during the COVID-19 Pandemic: A Single Centre Prospective Study. Acıbadem Univ Health Sci. 2022;13(4):491–7.
• Gencer B, Arslan MM, Doğan Ö. A pediatric forearm fracture case with delayed union, re-fracture, and COVID-19 pandemics-related surgical delay. Northwestern Med J. 2023;3(1):62-66.
• Tay KJD, Lee YHD. Trauma and orthopaedics in the COVID-19 pandemic: breaking every wave. Singapore Med J. 2020;61(8):396-8.
• Gencer B, Çulcu A, Mert O, Doğan Ö. Did We Do It Right? The Effect of Postponing Elective Orthopedic Surgeries Due to the Pandemic on the Quality of Life. Acıbadem Univ Health Sci. 2022;13(3):345–51.
• Yavuz İA, Kahve Y, Aydin T, Gencer B, Bingöl O, Yıldırım AÖ. Comparison of the first and second waves of the COVID-19 pandemic with a normal period in terms of orthopaedic trauma: Data from a level 1 trauma centre. Acta Orthop Traumatol Turc. 2021;55(5):391-5.
• Guran O, Ozmanevra R, Kuyumcu M, Cakmakci A, Aman T. The management of orthopedic trauma surgery during the COVID-19 pandemic in Turkey. Acta Orthop Belg. 2022;88(2):269-74.
• Guo X, Wang J, Hu D, et.al. Survey of COVID-19 Disease Among Orthopaedic Surgeons in Wuhan, People’s Republic of China. J Bone Joint Surg Am. 2020;102(10):847-54.
• Majidi H, Niksolat F. Chest CT in patients suspected of COVID-19 infection: A reliable alternative for RT-PCR. Am J Emerg Med. 2020;38(12):2730-2.
• Randelli PS, Compagnoni R. Management of orthopaedic and traumatology patients during the Coronavirus disease (COVID-19) pandemic in northern Italy. Knee Surg Sports Traumatol Arthrosc. 2020;28(6):1683-9.
• Zhu Y, Chen W, Xin X, et.al. Epidemiologic characteristics of traumatic fractures in elderly patients during the outbreak of coronavirus disease 2019 in China. Int Orthop. 2020;44(8):1565-70.
• Tay K, Kamarul T, Lok WY, et.al. COVID-19 in Singapore and Malaysia: Rising to the Challenges of Orthopaedic Practice in an Evolving Pandemic. Malays Orthop J. 2020;14(2):7–15.
• Özdemir G, Karlıdağ T, Bingöl O, et.al. Systematic triage and treatment of earthquake victims: Our experience in a tertiary hospital after the 2023 Kahramanmaras earthquake. Jt Dis Relat Surg. 2023;34(2):480-7.
• Turgut A, Arlı H, Altundağ Ü, Hancıoğlu S, Egeli E, Kalenderer Ö. Effect of COVID-19 pandemic on the fracture demographics: Data from a tertiary care hospital in Turkey. Acta Orthop Traumatol Turc. 2020;54(4):355-63.