Background: Social practices, hospital guidelines, and government regulations in response to COVID-19 have influenced orthopaedic practice volumes. The widespread cessation of non-essential surgeries has greatly decreased elective practices, but the extent to which trauma volumes diminish remains unknown. Access to common sites of orthopaedic injury was limited during this period, including organized sports, playgrounds, and travel. Methods: To examine the effect of COVID-19 in pediatric and adult practices, considering local responses to the pandemic, weather effects, and school activity. We retrospectively examined orthopaedic clinic changes for the first five months of the year in 2019 and 2020. An administrative database was used to obtain volume data for OR cases, OP visits, and OP clinic procedures. Temperature and precipitation records were collected for the same period. Results: All aspects of the adult practice greatly decreased in March, April, and May compared to the previous year. The largest decreases in OR cases occurred in April for adults, with a slight increase in May, but volumes remained decreased compared to the previous year. Pediatric and adult OP visits and OR cases dropped similarly in March and April. This trend continued into May for OP visits, but only pediatric OR visits increased in May. Conclusion: Practice trends from 2019 to 2020 established in January and February abruptly altered in the following months. Institutional cessation of elective procedures and government issued statewide stay-at-home orders greatly impacted orthopaedic volumes during this period. Decreased opportunity for social activity contributed to drops in pediatric and adult trauma. Proactive responses by local schools aided in a more rapid decline of pediatric trauma compared to adults in the month of March.
The DFEO and patellar advancement are performed through a midline incision under tourniquet control. To expose the patellar tendon, a midline incision through fascia Retrospective study
Case: Tarsal Coalition is a musculoskeletal deformity of the lower limb with a progression that is often asymptomatic until ossification of the calcaneoavicular coalition in the second decade. We report a novel case of a patient symptomatic before ossification of the coalition with resolution of symptoms coinciding with visual appreciation of the condition. Conclusion:This case demonstrates two unique components of the development of tarsal coalition that are not well described in the literature currently: The rapid development of bilateral calcaneonavicular coalitions and transition from symptomatic to asymptomatic as the coalitions matured. Check for updateswith activity. Prior to this, she did not have any past medical history. Her biological father had a history of tarsal coalition. The plan during this time was to consult orthopedics for additional examination. The initial orthopedic examination showed increased tightness in her hamstring muscle and gastrocnemius bilaterally. Examination of the feet revealed flat straight feet with full range of motion of her hindfoot and midfoot. Gait, coordination, and balance were normal. X-ray radiographs were taken at this visit and were unremarkable (Figure 1A and Figure 2A). The patient's family was given instructions to start a hamstring and gastrocnemius stretching regime for the patient and orders to use orthotics in her shoes.13 months later at age 10, the patient presents to the emergency department with an injury to her left great toe. X-ray radiographs taken during her ED visit did not show any structural damage to her great toe but did show anomalies in the tarsal bones that prompted imaging of the uninjured foot. Imaging was reviewed at her next orthopedic visit several months later and indicated bilateral calcaneonavicular coalition that were not present on radiographs during initial
The coronavirus SARS-CoV-2 (COVID-19) pandemic has necessitated the development of novel hospital guidelines across a wide variety of specialties and clinical environments. Surgeons have been profoundly affected in many areas due to the widespread cessation of non-essential surgeries across the country. This has been particularly notable for orthopaedic surgeons, as elective surgeries compromise approximately 47% of orthopaedic care expenditures [1]. Many states have placed restrictions on elective procedures, but few have provided a definition of "elective," and only five states provided guidelines specific to orthopaedics [2]. Choosing which surgeries are classified as elective is not easily determined without some controversy and surgeons have been burdened with the challenge of identifying which operations to postpone [1][2][3][4][5]. The extent to which elective practices diminish is unknown, but a decline in volume is nearly certain. However, it remains unclear how our hospital, social, and government responses will affect trauma volumes and care.
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