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      Coronavirus-Pandemie und ihre Auswirkungen auf Orthopädie und Unfallchirurgie: Operationen, Risiken und Prävention? Translated title: Coronavirus pandemic and its effect on orthopedics and trauma surgery: surgery, risks and prevention?

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          Abstract

          Um die Auswirkungen von COVID-19 zu beurteilen, müssen allen Mitarbeitern im Gesundheitssystem die Symptome und Verläufe der Erkrankung bekannt sein. Erfahrungen und Studien aus den initial am stärksten betroffenen Regionen China und Italien geben erste Rückschlüsse auf Fragen wie Verlauf der Infektion und Risiko für das Krankenhauspersonal. Hier deutet sich an, dass operativ versorgte COVID-19-Patienten ein höheres Risiko im Vergleich zu Nichtinfizierten haben. Weiterhin scheint das OP-Personal einem Infektionsrisiko ausgesetzt zu sein.

          Um das Gesundheitssystem vor einem Kollaps zu bewahren, müssen Ressourcen an anderer Stelle eingespart werden. Dazu müssen elektive Operationen reduziert werden. Um Kriterien zu entwickeln, wann welche Operationen durchgeführt werden können, wird die Pandemie in verschiedene Phasen eingeteilt. Diese orientieren sich an der Entwicklung der Pandemiekurve. Dabei sollten bei der Entscheidung, ob eine Operation durchführbar ist, verschiedene Aspekte berücksichtigt werden (Stadium der Pandemie, Funktionsstörung bei Unterlassung, Konflikt mit Ressourcen zur COVID-19-Behandlung, Alternative: ambulante Operation).

          Die Empfehlungen zur Durchführung von Operationen sollten immer an die aktuelle, regionale und epidemiologische Situation des Hauses und des jeweiligen Einzugsgebietes angepasst werden. Zu diesem Zwecke ist es sinnvoll, ein lokales Komitee im Krankenhaus zu bilden, das diese Lagebeurteilung täglich vornimmt. Generelle Operationsverbote erscheinen medizinisch nicht sinnvoll.

          Translated abstract

          In order to assess the effects of COVID-19, all health care workers must be aware of the symptoms and course of the disease. Experience and studies from the regions most affected in China and Italy give preliminary information on issues such as the course of infection and the risk to hospital staff. This suggests that surgically treated COVID-19 patients have a higher risk compared to noninfected patients. The surgical staff also appear to be at increased risk of infection. Furthermore, to prevent the health care system from collapse, resources must be saved elsewhere. Elective operations must be reduced. In order to develop criteria for which operations can be performed, the pandemic is divided into different phases. These are based on the development of the pandemic curve. Various aspects should be taken into account when deciding whether an operation is feasible (stage of pandemic, dysfunction in case of omission, conflict with resources for COVID-19 treatment, alternative: outpatient surgery). Thus, the recommendations for carrying out operations should always be adapted to the current, regional and epidemiological situation of the hospital. For this purpose, it is necessary to form a local committee in the hospital to carry out this assessment on a daily basis. General surgical bans do not seem to make medical sense.

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          Estimation of the reproductive number of novel coronavirus (COVID-19) and the probable outbreak size on the Diamond Princess cruise ship: A data-driven analysis

          Highlights • The novel coronavirus (COVID-19) pneumonia has caused 355 confirmed cases on the Diamond Princess cruise ship as of February 16, 2020. • We estimated that the Maximum-Likelihood (ML) value of reproductive number (R0) was 2.28 for COVID-19 outbreak at the early stage on the ship. • If R0 value was reduced by 25% and 50%, the estimated total number of cumulative cases would be reduced from 1296 (1145–1452) to 874 (780–978) and 573 (512–644) as of February 26, 2020, respectively.
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            Characteristics and Early Prognosis of COVID-19 Infection in Fracture Patients

            Background: Studies of the novel coronavirus-induced disease COVID-19 in Wuhan, China, have elucidated the epidemiological and clinical characteristics of this disease in the general population. The present investigation summarizes the clinical characteristics and early prognosis of COVID-19 infection in a cohort of patients with fractures. Methods: Data on 10 patients with a fracture and COVID-19 were collected from 8 different hospitals located in the Hubei province from January 1, 2020, to February 27, 2020. Analyses of early prognosis were based on clinical outcomes and trends in laboratory results during treatment. Results: All 10 patients presented with limited activity related to the fracture. The most common signs were fever, cough, and fatigue at the time of presentation (7 patients each). Other, less common signs included sore throat (4 patients), dyspnea (5 patients), chest pain (1 patient), nasal congestion (1 patient), headache (1 patient), dizziness (3 patients), abdominal pain (1 patient), and vomiting (1 patient). Lymphopenia (<1.0 × 109 cells/L) was identified in 6 of 10 patients, 9 of 9 patients had a high serum level of D-dimer, and 9 of 9 patients had a high level of C-reactive protein. Three patients underwent surgery, whereas the others were managed nonoperatively because of their compromised status. Four patients died on day 8 (3 patients) or day 14 (1 patient) after admission. The clinical outcomes for the surviving patients are not yet determined. Conclusions: The clinical characteristics and early prognosis of COVID-19 in patients with fracture tended to be more severe than those reported for adult patients with COVID-19 without fracture. This finding may be related to the duration between the development of symptoms and presentation. Surgical treatment should be carried out cautiously or nonoperative care should be chosen for patients with fracture in COVID-19-affected areas, especially older individuals with intertrochanteric fractures. Level of Evidence: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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              Survey of COVID-19 Disease Among Orthopaedic Surgeons in Wuhan, People’s Republic of China

              Background: Coronavirus disease 2019 (COVID-19) broke out in Wuhan, the People’s Republic of China, in December 2019 and now is a pandemic all around the world. Some orthopaedic surgeons in Wuhan were infected with COVID-19. Methods: We conducted a survey to identify the orthopaedic surgeons who were infected with COVID-19 in Wuhan. A self-administered questionnaire was distributed to collect information such as social demographic variables, clinical manifestations, exposure history, awareness of the outbreak, infection control training provided by hospitals, and individual protection practices. To further explore the possible risk factors at the individual level, a 1:2 matched case-control study was conducted. Results: A total of 26 orthopaedic surgeons from 8 hospitals in Wuhan were identified as having COVID-19. The incidence in each hospital varied from 1.5% to 20.7%. The onset of symptoms was from January 13 to February 5, 2020, and peaked on January 23, 8 days prior to the peak of the public epidemic. The suspected sites of exposure were general wards (79.2%), public places at the hospital (20.8%), operating rooms (12.5%), the intensive care unit (4.2%), and the outpatient clinic (4.2%). There was transmission from these doctors to others in 25% of cases, including to family members (20.8%), to colleagues (4.2%), to patients (4.2%), and to friends (4.2%). Participation in real-time training on prevention measures was found to have a protective effect against COVID-19 (odds ratio [OR], 0.12). Not wearing an N95 respirator was found to be a risk factor (OR, 5.20 [95% confidence interval (CI), 1.09 to 25.00]). Wearing respirators or masks all of the time was found to be protective (OR, 0.15). Severe fatigue was found to be a risk factor (OR, 4 [95% CI, 1 to 16]) for infection with COVID-19. Conclusions: Orthopaedic surgeons are at risk during the COVID-19 pandemic. Common places of work could be contaminated. Orthopaedic surgeons have to be more vigilant and take more precautions to avoid infection with COVID-19. Level of Evidence: Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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                Author and article information

                Contributors
                wolf.petersen@jsd.de
                Journal
                Knie J.
                Knie Journal
                Springer Medizin (Heidelberg )
                2662-4028
                2662-4036
                20 April 2020
                : 1-9
                Affiliations
                GRID grid.461755.4, ISNI 0000 0004 0581 3852, Sportklinik Berlin und Klinik für Orthopädie und Unfallchirurgie, , Martin Luther Krankenhaus, Berlin Grunewald, ; Caspar-Theyß-Straße 27–31, 14193 Berlin, Deutschland
                Article
                52
                10.1007/s43205-020-00052-1
                7168570
                6621a1a5-78a9-4dab-bb57-0774b7325fb5
                © Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2020

                This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

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                covid-19,sars-cov‑2,orthopäde,unfallchirurg,pandemie,orthopedic,trauma surgeon,pandemic

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