Open Access Original Research Article

The Impact of the COVID-19 Pandemic on the Provision of Minor Orthopaedic Trauma Procedures in Ireland

D. M. Moore, J. P. Gibbons, J. Sorensen, D. P. Moore, J. F. Quinlan

Asian Journal of Orthopaedic Research, Page 1-11

Background: The Covid-19 pandemic has affected healthcare systems worldwide including a reduction in the volume of non-essential procedures and treatments. This study explores the impact on the provision of minor orthopaedic trauma procedures from public hospitals in Ireland during the first wave of the Covid-19 pandemic.

Methods: Administrative data from 2018-2020 on hospital episodes with minor orthopaedic trauma procedures were obtained and grouped into six categories of index procedures. The Covid-19 pandemic was defined from 29th February 2020 when the first case was registered in Ireland until 30th September 2020. The number of admissions, percentage of day cases, and the average length of stay for inpatients were compared with similar periods in 2018 and 2019.

Results: There were 1433 (-27.0%) fewer admissions for the index procedures during the first 30 weeks of the Covid-19 pandemic than during the similar weeks of 2018 and 2019. The proportion of day cases remained largely unchanged (37.7% vs 38.1%) while the average length of stay for inpatients reduced significantly (p=0.006) from 3.1 to 2.7 days during the pandemic.

Conclusion: During the first wave of the Covid-19 pandemic, there was a substantial reduction in the volume of minor orthopaedic trauma procedures and a reduction in the average inpatient length of stay for patients with minor orthopaedic injuries.

Open Access Original Research Article

Importance of Percutaneous Vertebroplasty in the Management of Spinal Metastases

Mohamed Seddik Eddine Akremi, Mehdi Bellil, Souha Bennour, Senda Bellila, Walid Balti, Mohamed Ben Salah

Asian Journal of Orthopaedic Research, Page 12-17

Introduction: Vertebral metastases are clinically manifested by severe pain, pathologic fracture, life threatening hypercalcemia, spinal cord compression and impaired quality of life. Therapeutical strategy depends on several factors such as: life expectancy, general condition of the patient and the number of spinal lesions. Vertebroplasty techniques, especially kyphoplasty, are becoming an increasingly important option for spinal metastases. Recent studies have shown the effect of vertebroplasty on postoperative pain of metastatic origin without prolonged follow-up.

The aim of our work is highlighting the short-term effect of vertebroplasty in the treatment of pain related to vertebral metastases and to study the effect on vertebral stability.

Methods: We conducted a single-centered retrospective study over a period of 4 years including 30 patients affected by spinal metastases without neurological signs with a total of 46 vertebroplasties.

Results: The mean age of our patients was 55.13 years. The average preoperative visual analogue scale (VAS) was 8.46 and reached an average of 2.73 maintained until the last follow-up of 2 years, attesting to the significant decrease in spinal pain (p<0.05).

The average Beck index increased from 0.58 preoperatively to 0.84 postoperatively, with a significant difference (p<0.05).

Angular kyphosis significantly decreased from a mean of 17.8° preoperatively to 7.3° postoperatively at the last follow-up (p<0.05).

Three cases of polymethacrylate (PMMA) cement leakage were noted, with no neurological compromise.

Conclusion: Spinal vertebroplasty techniques are reliable, effective and reproducible in the management of vertebral metastatic lesions, enabling stability with pain control.  

Open Access Original Research Article

A Prospective Study of Four-part Intertrochanteric Femur Fractures Treated with Cemented Bipolar Prostheses in Elderly Patients

Lakhan Pratap, Jitendra Aloria, Satyendra Meena, Mahendra Gosaliya, Ajeet Singh

Asian Journal of Orthopaedic Research, Page 18-26

Introduction: The care of comminuted inter trochanteric femur fractures in the elderly is complicated because to the difficulty of anatomical reduction in osteoporotic bones, the requirement for prolonged immobilization following surgery, and the increased risk of screw cut out in poor quality bone. Prolonged Bed sores, chest infections, and deep vein thrombosis are among problems of immobility. Both morbidity and mortality are increased as a result of reliance and psychosocial side effects.

The Purpose of this Study: “To assess the functional outcome of cemented bipolar hemiarthroplasty in patients over 60 years old with comminuted intertrochanteric femur fractures”.

Materials and Methods: This study was conducted in the Department of Orthopedics, Govt. Medical College, and affiliated groups of hospitals in Kota between 2017 and 2019. The patients were all over 60 years old and had an intertrochanteric fracture that was unstable. Exclusion criteria: Patient is unwilling to undergo surgery and is medically unfit.

Results: The average age in our research was 77.3 years. Hypertension was the most prevalent linked medical issue, accounting for 33% of the total. Cerclage wire was used to keep the pieces of the Greater trochanter together (46.66%). In seven cases, calcar reconstruction was performed (23.33%). The patients were followed up on at six weeks, three months, six months, nine months, and one year after surgery. After 6 weeks, 12 patients were able to walk without assistance, 10 with a cane, and 8 with a walker. Squatting and sitting cross-legged were not recommended for any of the patients.

Conclusion: For older patients with comminuted inter trochanteric femur fractures, the surgery allowed for quick mobilization, early recovery to pre-injury levels, and provided a long-term solution.