The Coronovirus Disease 2019 –(COVID-19) pandemic had a significant impact on the health care system and medical staff around the world. The orthopedic units were also subject to new restrictions and regulations. Therefore, the aim of our research was to assess how the COVID-19 pandemic affected orthopedic wards in the last year in Poland. We created an online survey, which was sent to 273 members of the Polish Society of Orthopedics and Traumatology. The survey contained 51 questions and was divided into main sections: Preparedness, Training, Stress, Reduction, Awareness. A total of 80 responses to the survey were obtained. In Preparedness section the vast majority of respondents (90%) replied, that they used personal protective equipment during the pandemic, however only 50% of the respondents indicated that their facility received a sufficient amount of personal protective equipment. Most of the respondents indicated that the pandemic negatively affected the quality of training of future orthopedists (69.4%) and that pandemic has had a negative impact on their operating skills (66,7%). In Reduction section most of the doctors indicated that the number of patients hospitalized in their departments decreased by 20–60% (61,2% respondents), while the number of operations performed decreased by 60–100% (60% respondents). The negative impact of pandemic on education was noticeable especially in the group of young orthopedic surgeons: 0–5 years of work experience (p = 0,029). Among the respondents, the level of stress increased over the last year from 4.8 to 6.9 (p <0.001). The greatest increase in the level of stress was observed among orthopedists working in country hospitals (p = 0,03). In section Awareness 36,3% of respondents feel well or very well informed about the latest Covid-19 regulations. In addition, most doctors (82.6%) believe that the Polish health care system was not well prepared to fight the pandemic and that the regulations applied so far are not sufficient to effectively fight the pandemic (66.2%). The COVID-19 pandemic has impact on orthopedics departments in Poland and negatively affected the quality of training of orthopedic surgeons and the level of stress.
Background: The COVID-19 pandemic has affected all of the medical specialties, including orthopedic oncology. Therefore, the aim of the study was to assess how it influenced the diagnostic and therapeutic processes for patients with bone neoplasms. Methods: We evaluated 87 patients treated due for bone neoplasms before (Group I, n = 36) and during the COVID-19 pandemic (Group II, n = 51). A delay in diagnosis was defined as the period between the initial clinical symptoms and the date of referral to an oncology center. The patients from Group II were asked to complete a short questionnaire regarding the COVID-19 pandemic. Results: The median general delay in diagnosis before the pandemic was 7 months, while during the pandemic, it was 10 months (p = 0.728). The biopsy delay was lower in the pre-pandemic group: median-6.5 vs. 12 days (p = 0.025). The patients from Group II were diagnosed with larger tumors compared to those in Group I: the median values were 75 vs. 56 mm (p = 0.025), respectively. After an X-ray examination, the bone neoplasms were suspected more frequently in the Group II: 63% vs. 44% cases (p = 0.024), respectively. In Group II, 20 (60.8%) cases of SARS-CoV-2 infection were reported, however, no respiratory failure cases were noticed. Conclusion: The pandemic affected the diagnostic process of primary bone tumors, resulting in delays in performing biopsies. During the pandemic, the patients reported larger diameters of their bone lesions.
Multitrauma is defined as injury involving two or more different body parts, with a condition that at least one of these injuries is life-threatening. They represent serious traumas, requiring treatment in the intensive care units and frequently surgical intervention. The objective of this study was epidemiological and clinical analysis of patients treated in 2015 year in Multitrauma Centre of the University Teaching Hospital no 1 in Szczecin, and comparison the results with outcomes of similar study conducted in the same Centre in 2007 year. Clinical material comprised medical notes of 82 patients, 52 men (63%) and 30 women (37%), with a mean age of 44 years, who sustained multitrauma injuries. An analysis included causes of traumas, spectrum of injuries, involvement of body parts, methods and outcomes of the treatment. Results. The most common cause of multitrauma was traffic accident - 45 cases (55%), followed by fall from height - 22 (27%) and other mechanism - 15 (18%). The most frequent component of multitrauma made bone fractures (spine, pelvis, limbs) - 64 cases (78%), followed by head traumas - 63 (77%), chest - 53 (65%) and abdominal 30 (36%) injuries. A total of 48 patients (58%) required surgical intervention, the most frequently fixation of bone fractures - 24 patients (29%), repair of abdominal and head injuries - 18 (22%) either. Of 82 treated patients 64 (78%) survived and 18 (22%) died. A mean period of stay in Multitrauma Centre was 23 days for survived patients and 17 days for those who died. Comparing to similar analysis conducted 8 years earlier, a change in involvement of particular body parts comprising multitrauma injury was observed: number of head injuries increased of 14%, number of chest traumas and bone fractures decreased of 21% and 11%, respectively. The survival rate improved of 10%.
The pattern of traumatic death is a subject of great interest in the worldwide literature. Most studies have aimed to improve trauma care and raise awareness of avoidable fatal complications. The objective of present study was an epidemiological and clinical analysis of causes of traumatic death of the patients treated in Multitrauma Centre of the University Teaching Hospital no 1 in Szczecin, over a period of 3 years (2017-2019). Material of the study comprised of medical data of 32 patients in a mean age of 63 years, who died following polytrauma injury. Time of death form admission to the Multitrauma Centre, primary cause of death, spectrum and sites of injuries, as well as method of treatment (operative or conservative) were variables considered in the analysis. Results. The predominant mechanisms of injury were traffic accidents - 22 cases (69%) followed by falls from height 8 (25%) and other mechanism - 2 cases (6%). The most common primary cause of death was brain injury - 17 patients (53%) followed by pelvic or spine fractures - 5 (16%). The predominant constituents of polytrauma were bony injuries (pelvis, spine and limbs) - 28 cases (87%), followed by head injuries - 25 (78%), chest - 24 (75%) and abdominal injuries - 17 (53%). Eighteen patients (56%) required operative treatment; craniotomy for brain injuries was the most commonly performed - in 11 patients followed by laparotomy - in five. Five other patients underwent endovascular procedure - embolization of pelvic arteries. Twelve patients (38%) died in the first two days from admission to the trauma centre, five (16%) in the first week and 15 later than one week form admission. Conclusions. Head injuries, pelvic fractures with associated retroperitoneal bleeding and severe injuries affecting several body parts were identified to be the most dangerous for polytrauma patients’ survival. A trend to decrease mortality due to haemorrhagic shock was observed, but it remains unchanged for central nervous system injuries.
Bone metastases are a great challenge in the practice of an orthopedic surgeon. Due to the development of oncological treatment, the approach to patients with bone metastases is changing. Previously, these patients were treated palliatively, mainly to decrease the pain intensity. However, with appropriate systemic, surgical and orthopedic treatment, patients with bone metastases often live for many years. Therefore, proper diagnosis and appropriate orthopedic treatment can significantly improve patients’ prognosis. On the other hand, poor qualification for surgery and selection of the wrong treatment method contribute to shortening the patients’ survival. Hence, knowledge of the diagnosis and qualification of patients for surgical treatment is essential in the practice of an orthopedist. In the presented review, the authors focused on summarizing the knowledge in the field of diagnostics, qualification for surgical treatment and orthopedic treatment methods for patients with bone diaphysis metastases.
Background. Scarf osteotomy is an effective method of surgical treatment of hallux valgus. The final impact of the procedure on patients’ physical activity has not been assessed so far. Our goals were to evaluate sports and physical activities in patients following the Scarf osteotomy and to compare these with clinical outcomes. Material and methods. The study included 79 patients who were treated for hallux valgus with a Scarf osteotomy in 2015-2016. The average age in the examined group at the time of surgery was 55.43 (± 11.97) years, while the follow-up was on average 3.13 (± 0.42) years. Physical activity was measured using the UCLA - Activity Score and Author’s Sport Specific Questionnaire. Clinical outcomes were evaluated with the American Orthopedic Foot and Ankle Score (AOFAS HMI) and compared to sports outcomes. Results. After the procedure, the frequency of undertaking physical activity increased by about 21% (p = 0.0005) and the time spent by patients during the week on sports (minutes per week) increase by about 19% (p = 0.005). The result of the UCLA – Activity Score after surgery increased by an average of about 4.7% (p = 0.016). The average satisfaction with the result of the surgery was 8.2 (1-10 scale). The majority of patients (67%) were able to maintain the amount of physical activity after the surgery and few patients (24%) were able to increase this amount. Conclusion. The study suggests that Scarf osteotomy has a positive effect on the ability of patients with hallux valgus to return to sport and physical activity.
Background and purpose: Revision procedures and the resulting bone loss are still a big challenge for orthopedic surgeons. Therefor we checked, what post-operative functional outcomes 3D printed Cone augments offer in patients with bone defects (AORI classification type 2 and 3) of the knee joint and does use of Cones can delay the necessity to use resection prothesis?Methods Data from 64 patients (M=22; W=42) who underwent a total knee arthroplasty (TKA) revision in two clinical hospitals were included in the retrospective analysis. 3D printed Cones were used in all patients. The Knee Society Clinical Rating System (KSS) and the range of motion in the knee joint were used for the functional assessment of patients.Results The mean follow-up was 22 months (range, 12 to 38 months). Survival for aseptic loosening at follow-up was 100%. Infection occurred in 2 (3.1%) patients. The mean KSS score increased from 12.75 points preoperatively to 66.56 points postoperatively (p <0.001). While the mean range of motion in the knee joint changed from 61.15 degrees preoperatively to 115.93 degrees postoperative (p <0.001).Conclusion Due to the good functional results of patients and the low rate of complications, 3D printed Cone augments seems to be a good solution for patients requiring a TKA revision procedure. When used in patients with bone defects classified as 2B and 3 (AORI), they can be a good alternative, delaying the need for resection prostheses.
Revision procedures and the resulting bone loss are a big challenge for orthopedic surgeons. Therefore, we checked what functional outcomes that 3D-printed cone augments can offer to patients with bone defects (Anderson Orthopedic Research Institute [AORI] classification type 2B and 3) in the knee and whether the use of cones can delay the necessity to use a megaprotheses. Data from 64 patients (M = 22; W = 42) who underwent total knee arthroplasty (TKA) revision were included in the analysis. The Knee Society Clinical Rating System (KSS) and the range of motion in the knee joint were used for the functional assessment. The mean follow-up was 28 months (range: 18–44 months). The survival rate for aseptic loosening at follow-up was 100%. Infection occurred in two (3.1%) patients. The mean KSS score increased from 12.75 points preoperatively to 66.56 postoperatively (p < 0.001). The mean range of motion in the knee changed from 61.15° preoperatively to 115.93° postoperatively (p < 0.001). 3D-printed cone augments seem to be a good solution for patients requiring a TKA revision procedure. When used in patients with bone defects classified as 2B and 3 (AORI), they can be a good alternative, delaying the need for megaprotheses.
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