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Purpose There are no previous epidemiological studies to represent the trends of tibia fractures in the urban setting. The purpose of our study was to provide unique epidemiological information on the incidence of tibia fractures requiring admission in the urban population of Singapore. Methods This is a retrospective review of clinical and radiological records encompassing three years period from 2012 to 2014 in a tertiary hospital in Northern Singapore, which covers an adult population of 550,000. Clinical information included demographics, mechanism of injury, and Gustillo-Anderson classification. Radiological records were evaluated by two of the authors and fractures were classified using the AO classification after consensus was reached. Results There were 214 cases of tibia fractures with a population incidence of 13 in 100,000. Among the tibia fractures, 47% were diaphyseal, 43% proximal and 10% distal. Majority of patients were males with a male to female ratio of 3 to 1. The mean age of females was 64 years while that of males was 40 years. The commonest mechanism of injury was road traffic accident, which contributed to 42% of cases, with motorcyclists making up 78% of all road traffic accidents. Compound fractures made up 23% of all fractures, most of which were Gustillo-Anderson type III; 69% of patients underwent surgical intervention. Conclusion The incidence of tibia fractures is 13/100,000 with a male-to-female ratio of 3:1. This incidence is lower than other studies, but the proportion of open fractures were surprisingly high at 23%. Distribution of fractures was unimodal with a peak in younger men and older women. This may signify a component of fragility among tibia fractures, especially proximal and distal fractures, which peaks above the age of 80 years old.

Purpose Timing of surgery for orthopaedic injuries continues to evolve, as an improved understanding of biology, healing, and technological advances continues to challenge historical norms. With the growing COVID-19 pandemic stretching limited healthcare resources, postponing surgery becomes an inevitable and unenviable task for most orthopaedic surgeons, and a shift in outpatient paradigms is required to mitigate poor outcomes in patients. Methods A scoping review of five databases on surgical timing and orthopaedic soft-tissue injuries was performed. All randomized controlled trials, longitudinal cohort studies, retrospective case series, systematic reviews, meta-analyses, and expert opinions were included for review, with 65 studies meeting the inclusion criteria. Results Better outcomes appear to be associated with early surgery for subluxations (< 1 week), recurrent dislocations (> 2 episodes), ligamentous and tendinous injuries (< 2 weeks), and bony avulsion injuries (< 3 weeks). Spinal conditions with neurological compromise should be operated on within 24 hours and spinal instability within 72 hours to reduce the risk of complications and poor outcomes. Conclusion Most soft-tissue orthopaedic injuries can be managed with outpatient ambulatory surgery in a semi-elective setting. As the paradigm for outpatient surgery shifts due to technological advances and the COVID-19 pandemic, it is critical for surgeons to time their surgery appropriately to maintain the high standards of orthopaedic practice.

Introduction The reintroduction of elective Orthopaedic surgery during the COVID-19 pandemic is likely to occur in phases, dictated by resource limitations and loco-regional pandemic status. Guidelines providing a general framework for the prioritisation of surgery have largely been based on surgical urgency, while scoring systems such as the MeNTS score may have limited applicability in the setting of Orthopaedic Surgery. We, therefore, propose an Orthopaedic-specific algorithm (‘MeNT-OS’), based on a modification of the MeNTS scoring system, that may be used to objectively triage and prioritise Orthopaedic cases during the COVID-19 pandemic. Methods We developed a scoring algorithm modified from the Medically Necessary Time-Sensitive Procedure (MeNTS) score with 13 unique variables, reflecting human and physical resource utilisation, surgical complexity, functional status of patients, as well as COVID-19 transmission risk. This score was then trialled in a sample of 118 cases, comprising 69 completed and 49 postponed cases. A higher overall score was intended to correlate with lower surgical prioritisation. Results The use of our scoring system resulted in higher average scores for postponed cases compared to completed cases, as well as higher median, 25th and 75th percentile scores. These results were statistically significant and showed concordance with the ad hoc decisions made before the scoring system was used, with the lower scores for completed cases suggesting a more favourable risk–benefit ratio for being performed as compared to the postponed cases. Conclusion The utility of the proposed ‘MeNT-OS’ scoring system has been assessed using data from our institution and offers an objective and systematic approach that is geared towards Orthopaedic procedures. We believe this scoring tool can provide Orthopaedic surgeons a safe and equitable approach to making difficult decisions on prioritisation of surgery during the COVID-19 period, and possibly other resource-limited settings in the future.

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