TREATMENT OF FRACTURES IN COVID-19 PATIENTS
Since February 2020, COVID-19 cases have been registered in many countries around the world. Today, it is clear that the COVID-19 pandemic has challenged the health care system in all countries. Huge financial and human resources are involved in providing care to infected patients. Traumatology is one of the branches of medicine that cannot suspend its activities despite the danger of an epidemic. The level of injuries decreases somewhat during periods of self-isolation and restrictions on social activities, but remains significant. In most cases, patients with acute trauma, if necessary for surgical treatment, were hospitalized for examination and preparation for surgical treatment. A large number of recommendations have been developed, which, however, can be combined in the following four important areas: prevention of unnecessary contacts, patient transfers, operations, limiting the number of consultations, visitors, reducing waiting times, treatment, personal protective equipment. All patients with fractures who can be treated conservatively and on an outpatient basis should not be hospitalized. In a pandemic, such cases should also include fractures in which surgical treatment shortens the patient's recovery time but does not improve the final long-term outcome of treatment, such as fractures of the clavicle, humerus, distal radial bone with acceptable fragment position. Detailed information on the selection of patients of all surgical profiles, screening, location and scope of care, anti-epidemic requirements for staff and patients, maintenance and exchange of medical records, recommendations for the rest of medical staff is contained in the recommendations of the American Academy of Orthopedic Surgeons. Priority A includes interventions that must be performed as a matter of urgency (up to 24 hours). These include open fractures; fractures of the femoral neck in young people; pelvic fractures accompanied by bleeding; fractures with damage to large vessels; compartment syndrome; dislocations; necrotic fasciitis; closed fractures when compromising soft tissues; complex fractures (external fixation only). Priority B includes urgent (up to 48 hours) operations to be performed for fractures of the femoral neck in the elderly, fractures of the talus, fractures of the femoral and tibial shafts and distal femur. All other fracture surgeries are a priority and can be performed within two weeks. All planned operations are prioritized D and E and can be postponed for three months or more. If outpatient treatment is not possible and emergency hospitalization is required for urgent / urgent surgical treatment (eg, femoral fracture), the patient should be screened for COVID-19 as soon as possible. If there is a viral disease clinic, hospitalization should be carried out in a specially designated box (ward / ward) until the patient's status is clarified. If the test is negative, the patient is transferred to the general department for further surgical treatment. The problem of fracture treatment in patients with COVID-19 is very relevant and needs further study. Despite the reduction in the incidence of COVID-19 worldwide, the development of treatment protocols for victims of fractures and respiratory endemic diseases is an urgent task. According to the literature, an individual approach to the treatment of each patient with skeletal bone fractures and COVID-19 significantly improves the results of treatment.
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