Inpatient Management for Orthopedics in COVID Pandemic

Inpatient management for Orthopedics in COVID Pandemic is by NOA . These lists are for the management of IPD or inpatient Department of Orthopedic Patients in Hospital.  Listed as follows.

Inpatient Management for Orthopedics in COVID Pandemic

• Postpone, defer or cancel all elective cases during a pandemic.
• There should be a “one-stop” model of care involving streamlines, a safe system of triage, assessment, treatment, and discharge, with a package of care designed to ensure no to minimal face to face follow up.
• A discharge pack may be provided to the patients with dressing pack, dressing, antibiotics, analgesia, and written self-follow-up instruction of wound care and 24 hours reachable telephone contact number.
• The aim is to reduce hospital admission and minimizing the length of stay
• Develop solutions for communication and distribution of trauma-related workload amongst nearby hospitals.
• Make sure the patient has been through triage and contact and travel history is known.
• Only admit the patient if there is no alternative.
• A daycare facility should be provided for ambulatory trauma.
• All inpatients must be wearing a surgical mask at all times.
• Life and limb-threatening conditions
• Emergent resuscitation and management for  Multiple injuries, pelvic and acetabular fractures with major hemorrhage, open fractures, compartment syndrome, exsanguinating injury
• Alternative management for the patient requiring soft tissue reconstruction
• Avoid multiple surgeries and long surgeries requiring critical care input
• Local flaps, skin graft, and intentional deformity should be preferred over complex reconstruction surgeries.
• Early amputation should be considered in a patient with an uncertain outcome with limb salvage to avoid multiple surgeries and prolonged hospital stay
• Base the decision about vascular injuries on clinical evaluation if imaging modality is not readily available.
• Regarding the lower limb fractures,
  • Hip and femoral fractures remain urgent.
  • Hemi-replacement should be considered rather than THR to facilitate early and faster surgery.
• General Trauma

1. 1. Surgeries in complex trauma should be planned in a way to minimize the hospital stay. If the staged approach is used, plan to discharge and re-admit the patient if possible.
   2. Daycare surgery for simple peri-articular fractures, foot and ankle surgery, forearm fractures.
   3. Wrist fractures may be treated with removable cast and splints.
   4. Use absorbable sutures as far as possible.
   5. Consider non-operative management of stable spinal fractures
   6. Treat non-unions in a delayed fashion. Failed implants, increasing deformities, and significant impact on daily functions may require urgent treatment.
   7. Consider leaving K wires unburied so that removal becomes easier
   8. Many children’s injuries may be definitively managed with conservative management at presentation, with a single follow up at 4 to 12 weeks, depending on the bone fracture.

• Other emergent and urgent condition
  1. Cauda equine syndrome
  2. Incomplete spinal cord injuries and conus medullaris syndrome
  3. Tumor condition likely to grow rapidly
  4. Osteomyelitis, septic arthritis, infected fractures with systemic sepsis. (Patient without systemic sepsis may be managed with suppression therapy. )

Pharmacological management of musculoskeletal disorders during the pandemic outbreak

• Long-acting corticosteroid injections may depress the immune system. Nonsteroidal anti-inflammatory medications (NSAIDs) have been linked with a more severe form of COVID19.
• Methylprednisolone has been linked to prolonged viral shedding, psychosis, and avascular necrosis in SARS-CoV and increased mortality in influenza.
• Intraarticular steroid administration reduces the efficacy of the influenza vaccine and suggests susceptibility to viral load.
• The current advice is not to take NSAIDs in COVID-19 and to use paracetamol to treat symptoms. It may cause “cytokine storms”. Taking the drug in the early stages of the disease may induce prolonged illness or more severe respiratory or cardiac complications. Non-steroidal anti-inflammatory drug for a long-term condition such as rheumatoid arthritis that it does not need to be stopped.

These are the guidelines by Nepal Orthopedic Association.Handbook of COVID-19 Prevention and Treatment Free download

Complete Guideline here