Did Covid-19 pandemic narrow the spectrum of surgical indications?

Abstract

Introduction. The Covid-19 outbreak has changed orthopedic practices more than expected. We are going through a period in which conservative treatment will become prominent when deciding on fractures with indistinct surgical margins in guidelines. Considering global tendency for surgical interventions in the pre-pandemic period, we tried to find out the answer to the following question: will conservative treatment be the shining star in the post pandemic period? Materials and Methods. 262 patients who were with “gray zone fractures-injuries” like extraarticular distal radius fracture, proximal humerus fracture and Weber type B ankle fracture was treated conservatively during March and August, 2020. Open or pathological fracture, fractures with vascular or neurological injury and fractures involving the articular joint were excluded. Results. 59 patients with proximal humerus fracture followed with arm-sling. Mean ASES scores at 6th was 48.3 and 69.9 12th week. 91 patients with Weber B-type ankle fracture were followed up with below-knee plaster for 6 weeks. American Orthopedic Foot & Ankle Score was 48 in the 6th week and 75 in the 12th week. 90 patients with distal radius fracture were followed up with plaster. Malunion was detected at 5 patients. Mean Quick Dash score at 6th weeks was 52.3 and 29.5 at 12th weeks. Mean wrist flexion was 450, wrist extension was 350, forearm supination 600 and forearm pronation was 700 at final control. Conclusions. The conservative treatment experiences we have gained from pandemic periods probably will change our treatment algorithm.

Outcome Analysis of Adult Distal Radius Fractures Managed During COVID-19 Pandemic

“…Many other studies have used Association for Osteosynthesis/Association for the Study of Internal Fixation) classification, but when this classification used with subdivisions, its reliability and reproducibility are reduced significantly [ 6 , 15 ]. In our study, a total of 23.4% patients required surgical fixation, which is less compared to other studies [ 6 , 12 , 16 ]. The average follow-up was 82.6 days, which is less than other studies done during pandemic [ 6 ], this is because our patients had satisfactory to good outcome at discharge.…”

“…The surgical fixation was considered in younger patients with unstable fracture and those with low risk of COVID infection. Keskin and Karslioglu’s study considered articular or periarticular fractures as “obligatory fractures to surgical treatment” during COVID pandemic [ 12 ]. In our study, we had more female patients and similar trends were noticed in other studies [ 6 , 13 , 14 ].…”

“…Five patients in our study required surgery for other complications and no patients had non-union. While other studies were done during COVID, there was no mention of malunion and other complications [ 12 , 14 ]. About 75.4% of our patients had good results and while 24% had satisfactory functional results at discharge.…”