Purpose The long incubation period and asymptomatic spread of COVID-19 present considerable challenges for health care institutions when patients return to elective surgery. Methods A retrospective review of the first adult elective cases performed between May 18, 2020 and June 14, 2020, after the end of lockdown was analysed in Belgium to answer the following questions: (1) for the 236 cancelled patients during the outbreak, how easy was rescheduling? (2) How useful was universal RT-PCR testing and chest CT scan for the 211 orthopaedic and trauma admissions? (3) How were surgical difficulty category, number of operations and complications different when compared to the pre-COVID period? (4) How would patients balance the benefit of surgery against the unknown risk of developing COVID-19? Results Before surgery, blood tests for anaesthesiology and imaging related to the surgical procedure were scheduled prior to universal testing (COVID-19 PCR and chest CT) performed 72-120 hours before surgery. Among the 211 asymptomatic patients who were tested before surgery, six had positive PCR, while no abnormality was found on the chest CT scan of all the patients. With this timing for tests, the 104 patients included in the current study for elective surgery were free of disease before undergoing surgery and remained without COVID-19 after surgery. Among the 366 cancelled patients during the outbreak, only 12% of the patients accepted to proceed with rescheduling immediately. Therefore, this resulted in a 70% reduction for elective surgery and in a 50% reduction for arthroplasties as compared to pre-COVID period. The rate of complications was not increased during the post-COVID period. A portion of patients have confused idea of screening and have difficulty to perceive the new rules of health organization. Conclusions Resumption of elective surgical procedures appears more difficult for patients than for surgeons with a low percentage of cancelled patients accepting to reschedule surgery. Universal testing allowed securing patients; however, surgeons must explore better patient perceptions regarding COVID-19 to facilitate a fully informed decision in the current period.
Terrible triad of the elbow and the Essex-Lopresti injury are both rare lesions with a historically poor clinical outcome. We present the case of a unique association of the two injuries with an elbow dislocation, radial and coronoid process fractures and a distal radioulnar joint dislocation due to an interosseous membrane rupture. The case was managed with closed reduction of the elbow dislocation and distal radioulnar joint followed by open reduction and repair of the damaged structures in the elbow and an unloading of the interosseous membrane. A high index of suspicion with a detailed examination of the elbow, forearm and wrist associated to a comprehensive imaging were mandatory for a complete diagnosis and an adequate treatment. Six months after the accident, the patient made a good recovery.
Objective: To examine measurement properties (inter-rater reliability, agreement, validity, and responsiveness) of the Cumulated Ambulation Score French translation in patients with hip fracture. Design: Methodological study. Setting: A 20-bed orthopedic unit and 20-bed geriatric unit. Subjects: About 140 consecutive patients with a mean (SD) age of 83 (12) years. Interventions: The English version of the Cumulated Ambulation Score used to evaluate basic mobility was translated into French following international guidelines. Two raters independently assessed all patients on postoperative days one, two, three, and 30 after a hip fracture surgery. Relative and absolute inter-rater reliability and responsiveness (effect size for improvement from postoperative day two to 30) were evaluated. Convergent validity was analyzed by Spearman’s correlation coefficient comparing the Cumulated Ambulation Score with two other measures on postoperative day two and 30. Main measure: Cumulated Ambulation Score. Results: The weighted Kappa value ranged from 0.89 to 1.0. The standard error of measurement and the smallest real difference of the Cumulated Ambulation Score ranged, respectively, from 0.12 to 0.23 and from 0.32 to 0.6 points, while the effect size reached 1.03 (95% CI 0.87–1.26). There was a strong positive correlation comparing the Cumulated Ambulation Score with the French Tinetti Assessment Tool ( r ⩾ 0.83) and the French Mini Motor Test ( r ⩾ 0.79). Conclusions: Our findings indicate that the Cumulated Ambulation Score’s French version is a reliable and valid tool to assess patients’ basic mobility with hip fractures.
Purpose Effectiveness of sufentanil sublingual tablet system (SSTS) compared to oral oxycodone in the management of postoperative pain after total knee arthroplasty (TKA) within an enhanced recovery after surgery (ERAS) protocol. Methods This pragmatic, parallel, open label, randomized controlled, trial enrolled 72 adult patients scheduled for TKA under spinal anesthesia following ERAS pathway. In addition to multimodal analgesia, patients received SSTS 15 mcg (SSTS group) or oral oxycodone extended release 10 mg twice daily and oral oxycodone immediate-release 5 mg up to four times daily on demand (Oxy group) to control pain during 48 h postoperatively. The primary endpoint was pain measured using a numeric rating scale at 24 h postoperatively. Time to first mobilization, side effects and patient satisfaction were also recorded. Results Median pain score at 24 h at rest was 3 [2–4] for Oxy group vs 2 [1.75–3] for SSTS group (p = 0.272) whereas median pain score on movement was 4 [3–6] vs 3 [2–5] respectively (p = 0.059). No difference in time to first mobilization was found between the two groups. The method of pain control was judged good/excellent for 83.9% of patients in the SSTS group compared with 52.9% in the Oxy group (p = 0.007). The incidence of nausea was 33% in SSTS group and 9% in Oxy group (p = 0.181). Conclusions In complement to ERAS multimodal analgesia, sublingual sufentanil 15 mcg tablet system did not show clinically significant pain improvement compared to oral oxycodone after total knee arthroplasty. Trial registration Clinical Trials: NCT04448457; retrospectively registered on June 24, 2020. https://clinicaltrials.gov/ct2/show/NCT04448457?cond=sublingual+sufentanil&cntry=BE&draw=2&rank=3
L'ostéoblastome est une tumeur osseuse bénigne ostéoformatrice qui survient chez l'adulte jeune avant 30 ans. Il se localise surtout au niveau du rachis et la diaphyse des os longs. La localisation au niveau du pied est exceptionnelle. Nous rapportons une observation chez une patiente âgée de 43 ans, révélée par des douleurs inflammatoires au niveau du bord latéral du pied, la radiologie standard étant initialement normale et même après trois mois d'évolution. Devant la persistance de la symptomatologie, un scanner a montré une image lacunaire bien limitée au niveau du cuboïde, sans effraction de la corticale, et une lésion en hypersignal en T1. Un kyste osseux du cuboïde a été suspecté. Un curetage comblement par l'allogreffe a été pratiqué. L'examen histologique de la pièce opératoire a confirmé le diagnostic d'ostéoblastome. Notre observation est particulière par l'âge de survenue au-delà de 30 ans et par la localisation inhabituelle au niveau du pied. Même si des formes agressives ont été rapportées dans la littérature, le pronostic de l'ostéoblastome est bon, et les récidives peuvent être évitées par un traitement chirurgical adéquat.Abstract Osteoblastoma is a rare, bone-forming neoplasm accounting for 1% of primary bone tumours. It arises in young patients and develops in long bones and posterior elements of the spine. It is very unusual for it to be found in the foot. We report a case in a patient aged 43, revealed by inflammatory pain at the lateral edge of the foot, whose X-ray was normal both initially and after 3 months. A CT scan showed osteolytic lesion on the cuboid with no breakage of the cortical and hypersignal lesion in the MRI. Cuboid bone cyst was suspected. Curetage with allograft was performed: histological examination of the surgical specimen confirmed the diagnosis of osteoblastoma.This case was unusual in that it occurred in a patient over the age of 30 and it was located in the foot. Osteoblastoma is categorized as a benign bone tumour, although an aggressive type of osteoblastoma has been described. Recurrence following curetage can be minimized by adequate resection.
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