CoViD-19 and ortho and trauma surgery: The Italian experienceItaly was the first country to report a case of Coronovirus in Europe and since the onset of the novel coronavirus (SARS-CoV-2) pandemic in China at the end of December 2019, it has been the country with the highest number of deaths worldwide to date ( Table 1 ) [1][2] .This might be explained by the high percentage of elderly people living in Italy, who make up the majority of the deaths. Moreover, the late recognition of this novel Coronavirus as a potentially serious type, unlike a seasonal flu, might have contributed to the wide spread of the disease [3] .The first cases of Coronavirus disease (CoViD) in Italy were detected in Rome, on January 20th, when a Chinese couple on holiday there resulted affected, and then in Codogno, a little village in Lombardy, on February 21st. However, an Italian Study confirmed that the virus had been circulating since the beginning of January [3] .On January 30th the Italian Government declared the state of emergency over the spread of Coronavirus disease.Afterwards, on February 22nd, the "Istituto Superiore di Sanità" (the highest Italian authority in the health-care field) ordered that some detected towns in Lombardy and Veneto, the so-called "red zones", be quarantined for 14 days. Nevertheless, given the rapid spread of the virus, northern Italy was initially locked down on March 7th but then the entire country had to be declared on lockdown on March 11th [4] .These restrictions were deemed necessary to stop virus diffusion, but, as they were not immediately applied to the whole nation, people kept on travelling around and with them did the virus.In a few weeks many changes had to be made to face the increasing need for medicine and ICU wards. Orthopaedics and Traumatology units, as well as each single hospital unit, had to help as much as possible in order to handle the epidemic in the best possible way.The Italian epidemic can be divided in two periods: an early phase, when only few CoViD patients were diagnosed in confined areas, and a second later phase: the former lasted from the middle of January to the country lockdown; the latter started with this declaration and is still on-going at the moment, due to the epidemic emergency state.

The Authors report a case of a 46 years old man affected by severe acute respiratory syndrome caused by Novel Coronavirus 2019 and admitted to our hospital. The patient required continuous positive airway pressure therapy (CPAP) in the hospital ward and subsequently orotracheal intubation while in intensive care unit. The patient laid in lateral decubitus position for several hours every day while receiving CPAP therapy. During the hospitalization, he reported limitation of range of motion of the left upper limb, without any history of acute or previous trauma. The clinical appearance of the arm was suggestive of pseudoparalytic shoulder. This case emphasizes the importance of proper body positioning during invasive and non-invasive mechanical ventilation in order to prevent peripheral nerve compression and further disability.

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