There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.
Abstract
The emergence of COVID-19 has impacted orthopaedic surgery worldwide. India, with
its large population and limited health resources, will be overwrought over the
coming days due to the number of cases of critically ill patients with COVID-19.
It is important to understand the challenges for orthopaedic (and other)
surgeons in India when dealing with patients during the COVID-19 pandemic. This
article highlights the challenges in the triaging of patients, care in dealing
with a patient with COVID-19 in orthopaedic surgery, and the effects on
academics and research activities; it also suggests immediate measures and
recommendations that also apply to other specialties.
Microorganisms are transmitted in hospitals mainly by contact, droplet, and airborne routes. Orthopaedic surgeons have a substantial occupational risk of contracting a blood-borne infection because of frequent handling of sharp instruments and objects during operative procedures. Aerosolization means the formation of aerosols and droplets when blood or other body fluids are mechanically disturbed. Smaller particles (<5 microm) will remain suspended in air. Pathogens that can survive in these small airborne particles may cause infection if they are inhaled. Aerosol-generating procedures in patients with tuberculosis or severe acute respiratory syndrome (SARS) may facilitate airborne transmission. The Hospital Infection Control Practices Advisory Committee and the Centers for Disease Control and Prevention have established guidelines for isolation precautions in hospitals.
Intra-capsular femoral neck fractures are seen commonly in elderly people following a low energy trauma. Femoral neck fracture has a devastating effect on the blood supply of the femoral head, which is directly proportional to the severity of trauma and displacement of the fracture. Various authors have described a wide array of options for treatment of neglected/nonunion (NU) femoral neck fracture. There is lack of consensus in general, regarding the best option. This Instructional course article is an analysis of available treatment options used for neglected femoral neck fracture in the literature and attempt to suggest treatment guides for neglected femoral neck fracture. We conducted the “Pubmed” search with the keywords “NU femoral neck fracture and/or neglected femoral neck fracture, muscle-pedicle bone graft in femoral neck fracture, fibular graft in femoral neck fracture and valgus osteotomy in femoral neck fracture.” A total of 203 print articles were obtained as the search result. Thirty three articles were included in the analysis and were categorized into four subgroups based on treatment options. (a) treated by muscle-pedicle bone grafting (MPBG), (b) closed/open reduction internal fixation and fibular grafting (c) open reduction and internal fixation with valgus osteotomy, (d) miscellaneous procedures. The data was pooled from all groups for mean neglect, the type of study (prospective or retrospective), classification used, procedure performed, mean followup available, outcome, complications, and reoperation if any. The outcome of neglected femoral neck fracture depends on the duration of neglect, as the changes occurring in the fracture area and fracture fragments decides the need and type of biological stimulus required for fracture union. In stage I and stage II (Sandhu's staging) neglected femoral neck fracture osteosynthesis with open reduction and bone grafting with MPBG or Valgus Osteotomy achieves fracture union in almost 90% cases. However, in stage III with or without AVN, the results of osteosynthesis are poor and the choice of treatment is replacement arthroplasty (hemi or total).
Publisher:
SAGE Publications
(Sage UK: London, England
)
ISSN
(Print):
0049-4755
ISSN
(Electronic):
1758-1133
Publication date
(Electronic):
21
April
2020
Publication date
(Print):
April
2020
Volume: 50
Issue: 2
Pages: 108-110
Affiliations
[1
]Associate Professor, Department of
Orthopaedics, Atal Bihari Vajpayee Institute of Medical Sciences, Dr. Ram Manohar
Lohia Hospital, New Delhi, India
[2
]Senior Consultant, Department of
Orthopaedic, Joint Replacement and Arthroscopic Surgery, Indraprastha Apollo
Hospitals, New Delhi, India
Author notes
[*]Vijay K Jain, Associate Professor,
Department of Orthopaedics, Atal Bihari Vajpayee Institute of Medical Sciences,
Dr. Ram Manohar Lohia Hospital, New Delhi 110001, India. Email:
drvijayortho@
123456gmail.com
scite shows how a scientific paper has been cited by providing the context of the citation, a classification describing whether it supports, mentions, or contrasts the cited claim, and a label indicating in which section the citation was made.