Covid-19 has adversely impacted the health care organizations by over burdening with Covid patients and suspending the elective surgeries and clinics. Hospitalization during pandemic may increase health cost of patients for elective and emergency procedure due to extra cost of covid testing and isolation. A single center retrospective study was conducted to quantify losses due to postponement of elective surgeries and extra cost for procurement of PPEs. The secondary objective was to see the effect of Covid −19 on the total costs of inpatient care during Covid era. Patient and method We included all the patients admitted in orthopedic section for operative intervention of fractures and elective procedures from January 1, 2020 to May 31, 2020. We divided this period into two halves; the first half was from January first to March 15 named as PreCovid Era and second half was from March 16, to May 31, 2020, termed as Covid Era. The total number of trauma procedures and elective procedures were compared in both eras. We compared six procedures each from upper and lower limit for cost analysis and length of stay. We also analyzed the extra cost for procurement of PPEs. Results A total 625 patients were admitted during study period; 417 in precovid and 208 in covid era. There was 50% reduction in patients admissions during Covid era. There was no statistically significant difference in age and gender of both groups. A total of 840 (591in preCovid era and 251 in Covid era) procedures were performed on these 625 patients. Elective and emergency procedures were significantly reduced in Covid era. There was 55.7% drop in the collective revenue generated in covid era as compared to that of Precovid era. The average length of stay was decreased in Covid era. No statistically significance difference was found in inpatient hospital charges of both groups except for two procedures ankle and proximal humeral fractures; that was significantly reduced in Covid era. There was significantly increase in use of PPE in covid era Conclusion The financial income of our service decreased more than 55% due to postponement of elective work. The number of elective and procedures related to musculoskeletal trauma also decreased. The cost for inpatient care did not increase during covid era. There was significant reduction in inpatient hospital stay during covid era. The hospital management had to spent additional expenses on procurement of PPEs.

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Aneurysmal bone cysts are tumors of bone occurring predominantly in the metaphyses of long bones and posterior elements of spine in adolescents and young adults. Radiographically, on x-rays they appear as eccentric metaphyseal expansile lytic lesions containing “fluid-fluid” levels. Computed tomographic scan and magnetic resonance imaging clearly define the cysts and fluid-fluid levels; the former delineates cortical expansion and the latter the fibrovascular component clearly. Magnetic resonance imaging is particularly useful in differentiating aneurysmal bone cysts from malignant lesions. Histologically, these cysts are characterized by fibrovascular tissue, multinucleated giant cells, inflammatory cells, fiber-osteoid, “blue bone,” and blood filled lacunae. Chromosomal translocation has been found, implying a neoplastic basis for the development of aneurysmal bone cysts. Malignant transformation has been reported where radiation therapy was used, and in cysts associated with sarcomas. A high ratio of cellular component as compared with osteoid, and a high mitotic index have been reported to be associated with higher recurrence after treatment. Management is aimed at addressing patients’ symptoms and preventing/treating fracture, and can broadly be divided into nonoperative management (drug and radiation therapy), minimally invasive strategies (angiographic embolization, percutaneous injections), and operative management (curettage and bone grafting, en bloc excision). To reduce chances of recurrence, adjuvants such as electrocautery, high speed burr, phenol, cryotherapy, and argon beam laser have been used with variable degrees of success. With contemporary management, a cure rate of 70%–90% is expected.

Background and purpose Neurotization of denervated muscles has been shown to improve muscle bulk, but the neuronal regeneration response has not been compared previously in different surgical techniques of neurotization. Thus, using a rat model of experimental skeletal muscle denervation, we studied neuronal regeneration following sensory neurotization by two methods: sensory nerve to motor branch of muscle and direct sensory nerve implantation to muscle.Material and methods The lateral head of the gastrocnemius muscle was denervated in 36 rats, of which the first 12 served as denervated controls. In the second group of 12, the sural nerve was anastomozed to the motor branch of the gastrocnemius muscle (sensory-tomotor nerve neurotization) and in the remaining 12 rats the sural nerve was split into 4 fascicles and embedded into 4 quadrants of the muscle (direct sensory nerve-tomuscle neurotization). Immunohistochemistry was used to examine nerve fibers in muscle containing the sensory neuropeptides substance P (SP) and calcitonin generelated peptide (CGRP), and general neuronal marker protein gene product 9.5 (PGP 9.5).Results Semiquantitative analysis showed that, compared to the control side, the number of nerve fibers on the experimental side was highest (p < 0.01) for group III (direct sensory nerve-to-muscle neurotization) for all 3 markers. The difference was 71%, 298%, and 254% for PGP 9.5, CGRP, and SP, respectively. Interpretation This method may be a good option for inducing neuronal regeneration in denervated muscles, and has therapeutic implications for prevention of atrophy of denervated muscles and as an adjunct for reconstruction of soft tissue defects.

Background Routine preoperative tests in healthy patients not only cause extra anxiety, but may delay treatment without influencing surgical plan. This has worse impact in resource-constrained settings where fee for service rather than health insurance is the usual norm. Investigators aim to determine if “routine” pre-operative tests are justified in healthy orthopedic patients. Methods We conducted a non-commercialized, non-funded matched case control study in tertiary care university hospital and a level-1 trauma centre for healthy patients (ASA-1&2) admitted from January 2014–December 2016 for elective orthopedic intermediate and major procedures. Cases (patient who had a change in his/her surgical plan after admission) and controls were selected independently of the exposure of interest then matched randomly to cases on age, gender and procedure type. Primary exposure was the routine preoperative lab tests, as defined by the American Society of Anesthesiologist, which included 13 blood tests. Analysis was done using Principle Component Analysis and Conditional logistic regression at univariate and multivariable levels reporting matched adjusted Odds Ratios. The data was reported in line with STROCSS criteria. Results Overall, 7610 preoperative tests were done for 670 patients with 62% men among cases and 53% men among controls with mean age of 49.9 22.5 years and 41.1 23.0 years, respectively. There were 1076 (14%) abnormal result that influenced surgical plan in 0.96% cases only. Matched adjusted OR with 95% confidence interval of primary exposure was insignificant. Conclusion Routine preoperative tests were superfluous and did not influence the surgical plan when adjusted for other variables in the model as well as after matching on potential confounders. This study would be amongst first steps to move towards an evidence based surgical practice for preoperative evaluation.