Orthopaedic Trauma Surgery Research Articles

Cannabis Exposure Decreases Need for Blood Pressure Support During General Anesthesia in Orthopedic Trauma Surgery.

Introduction:As cannabis use continues to increase in popularity, it is important to investigate how it impacts public health in all sectors of the population, including patients undergoing anesthetic management. This retrospective study focuses on the orthopedic trauma population presenting through an emergency department (ED) and receiving a urine drug screen (UDS) with subsequent urgent surgical intervention. We aimed to evaluate differences in response to general anesthesia in patients with exposure to THC, a major cannabinoid, compared to controls that screened negative for THC.Materials and Methods:All ED visits at UC Irvine, a level 1 trauma center between November 4, 2017 and January 7, 2020, were evaluated in this study. Only adult patients who received a UDS and underwent urgent orthopedic trauma surgery within 48 h of ED visit were included in this study. Additional inclusion criteria required an anesthesia time greater than 1 h as well as anesthesia induction and intubation while in the operating room. Overall, we analyzed a total of 221 adult patients.Discussion:When adjusting for demographic variability, there were statistically significant differences in response to general anesthesia between these two groups. The THC-positive (THC(+)) group was less likely to receive intraoperative vasopressors, had higher mean arterial blood pressure and mean diastolic blood pressure, needed less total fluid input and had a lower overall fluid balance. Chronic exposure to THC has been shown to downregulate cannabinoid 1 receptors and cause alterations in endocannabinoid tone. These are two potential mechanisms by which the THC(+) group in our study may have become more resistant to the typically observed hypotensive effects of general anesthesia.Conclusion:The present study suggests that prior use of cannabis, objectively assessed by urinalysis, results in a decreased need for blood pressure support during general anesthesia. The physiological basis for this phenomenon is unclear, but possible causes might include the downregulation of vascular cannabinoid receptor 1 and/or altered endocannabinoid levels after exposure to cannabis.

The Efficacy and Safety of Tranexamic Acid Treatment in Orthopaedic Trauma Surgery.

Tranexamic acid (TXA) is a drug used to control hemorrhage by preventing the breakdown of fibrin. TXA is a cost-effective treatment for trauma patients across a variety of economic settings. Concerns of TXA causing thromboembolic events (TEEs) in orthopaedic trauma patients are not supported by evidence. TXA has been shown to reduce blood loss in hip fracture surgery.

3D Printed Hydroxyapatite Nanocomposite Biomaterials in Orthopedic Trauma Surgery

With the continuous development of technology, using biological three-dimensional (3D) printing technology to prepare hydrogel stent for cartilage construction has great potential in soft tissue repair. In this study, the cartilage stent was prepared by cell-controlled assembly technology, the gelatin sodium alginate (GSA) was selected as the basic material and the nano-hydroxyapatite (n-HAP) was undertaken as the reinforcing material of the basic hydrogel, and the cell-controlled technology was used to assemble the n-HAP hydrogel stent with different composite ratios. While the performance of the stent material was characterized, the hydrogel material prepared for traumatic thoracolumbar fracture (TTF) was adopted for filling treatment during the percutaneous kyphoplasty (PKP). The results showed that compared with the GSA stent, addition of n-HAP can optimize accuracy of 3D printing, increase stability and mechanical strength of stent, and tested average elastic modulus of the composite hydrogel material is 24.58 ± 1.05 MPa. It suggested that addition of n-HAP can improve biodegradability of stent while adjusting the surface roughness of the stent. The biocompatibility test of n-HAP hydrogel stent indicated that the stent material was non-toxic and could support the adhesion and growth of mouse chondrocytes. After culture for 1 week after the 3D printing, the proportion of living cells reached more than 90%. Under the action of the composite hydrogel stent material, the visual analogue scale (VAS) score of patient decreased dramatically (from 8.9 to 1.8), the Oswestry disability index (ODI) decreased from 83.65 before surgery to 36.89 after surgery (P < 0.05), and the anterior vertebral height (AVH) of patient increased from 2.46 cm to 2.96 cm, which was 2.76 cm in the last follow-up test (P < 0.05). In summary, the composite hydrogel stent prepared in this study could meet the needs of cartilage tissue factories and showed good clinical effects in the treatment of TTF.

Allies in Orthopaedic Trauma Surgery.

From the casting couch to the board room, the media, and beyond, the topic of sexual harassment and bullying can no longer be ignored. Sexual harassment and bullying in medicine has the potential to be the next big headline on these topics. The culture in medicine and especially the hierarchy in surgery often permit this behavior. To improve the culture in orthopaedic surgery regarding sexual harassment and bullying, education must occur. With education, comes acknowledgment and recognition. This permits an ability to act on and improve the culture. This paper will start the dialogue of this difficult topic and provide a call to action for sexual harassment and bullying to become “Never events”.

Biofilm and its implications postfracture fixation: All I need to know.

Biofilm represents an organized multicellular community of bacteria having a complex 3D structure, formed by bacterial cells and their self-produced extracellular matrix. It usually attaches to any foreign body or fixation implant. It acts as a physical protective barrier of the bacteria from the penetration of antibodies, bacteriophages, granulocytes and biocides, antiseptics, and antibiotics. Biofilm-related infections will increase in the near future. This group of surgical site infections is the most difficult to diagnose, to suppress, to eradicate, and in general to manage. Multispecialty teams involved in all stages of care are an effective way to improve results and save resources and time for the benefit of patients and the health system. Significant steps have occurred recently in the prevention and development of clever tools that we can employ in this everlasting fight with the bacteria. Herein, we attempt to describe the nature and role of the "biofilm" to the specific clinical setting of surgical site infections in the field of orthopaedic trauma surgery.

Outcomes of orthopaedic trauma surgery in COVID-19 positive patients.

Objectives:To investigate outcomes for operative orthopaedic trauma in patients who tested positive for coronavirus disease 2019 (COVID-19) during the height of the COVID-19 pandemic in New York.Design:Retrospective case series.Setting:Urban Level-1 academic trauma center.Patients/participants:Thirteen patients diagnosed with COVID-19 who underwent surgical management for orthopaedic trauma between January 21, 2020 and May 11, 2020.Intervention:Does not apply to this study.Main outcome measurements:Complications including death, coma lasting more than 24 hours, prolonged mechanical ventilation, unplanned intubation, blood transfusion, postoperative pneumonia, cerebrovascular event, thromboembolic event, myocardial infarction, urinary tract infection, acute renal failure, septic shock, return to the operating room, wound dehiscence, surgical site infection, graft/prosthesis/flap failure, and peripheral nerve injury.Results:Two (18%) patients had symptoms of COVID-19 (cough, shortness of breath, fevers, chills, nausea/vomiting, diarrhea, abdominal cramps/pains) on admission. Average length of stay (standard deviation) was 6.6 (4.31) days. Average time to follow up was 29 (10.77) days. Three (27%) patients developed pneumonia postoperatively and 1 (9%) underwent unplanned intubation. One (9%) patient was intubated for greater than 48 hours. Two (18%) patients developed postoperative deep venous thromboembolism. Three (27%) patients developed acute renal failure postoperatively. Six (55%) patients underwent blood transfusion intraoperatively or postoperatively. Two (18%) patients died postoperatively.Conclusion:In this small series surgical management in Coronavirus-19 positive patients with skeletal injuries was successfully accomplished with patient anticoagulation, hematologic, and pulmonary status in mind. Therapeutic anticoagulation and patient hematologic status were optimized prior to the operating room to minimize development of venous thromboembolism and avoid blood transfusion.Level of evidence:Level IV prognostic

Biomarkers to Guide the Timing of Surgery: Neutrophil and Monocyte L-Selectin Predict Postoperative Sepsis in Orthopaedic Trauma Patients.

Deciding whether to delay non-lifesaving orthopaedic trauma surgery to prevent multiple organ failure (MOF) or sepsis is frequently disputed and largely based on expert opinion. We hypothesise that neutrophils and monocytes differentially express activation markers prior to patients developing these complications. Peripheral blood from 20 healthy controls and 162 patients requiring major orthopaedic intervention was collected perioperatively. Neutrophil and monocyte L-selectin, CD64, CD11, CD18, and CXCR1 expression were measured using flow cytometry. The predictive ability for MOF and sepsis was assessed using the Receiver Operating Characteristic (ROC) comparing to C-reactive protein (CRP). Neutrophil and monocyte L-selectin were significantly higher in patients who developed sepsis. Neutrophil L-selectin (AUC 0.692 [95%CI 0.574–0.810]) and monocyte L-selectin (AUC 0.761 [95%CI 0.632–0.891]) were significant predictors of sepsis and were not significantly different to CRP (AUC 0.772 [95%CI 0.650–0.853]). Monocyte L-selectin was predictive of MOF preoperatively and postoperatively (preop AUC 0.790 [95%CI 0.622–0.958]). CD64 and CRP were predictive of MOF at one-day postop (AUC 0.808 [95%CI 0.643–0.974] and AUC 0.809 [95%CI 0.662–0.956], respectively). In the perioperative period, elevated neutrophil and monocyte L-selectin are predictors of postoperative sepsis. Larger validation studies should focus on these biomarkers for deciding the timing of long bone/pelvic fracture fixation.

487 Reducing Intraoperative Fluoroscopic Radiation Exposure in Orthopaedic Theatres at A Trauma Centre

Abstract Introduction Intraoperative fluoroscopic imaging in orthopaedic trauma surgery subject’s theatre staff and patients to increasing radiation exposure and its detrimental health effects. This audit cycle uses a target maximum for total number of intraoperative fluoroscopic images taken, as defined by recently published reference values, to reduce intraoperative radiation exposure. Method This is a two-phase audit cycle retrospectively reviewing all trauma operations over a 12-month period (456 cases) and a 10-month period (256 cases) after disseminating the target standards through posters and focused training. Audit standards describe target maximum total intraoperative images taken for 5 commonly performed procedures, applicable to 33% of total cases. Operative notes, total intraoperative image count and radiation dose report were reviewed through ORMIS and PACS. Results Audit standard compliance improved/remained at 100% in 4/5 of the investigated ‘common procedures’: from 2/5 procedures <80% compliance and 1/5 procedures =100% compliance initially, to 0/5 procedures <80% compliance and 2/5 procedures =100% compliance target upon re-audit. This translated to an improvement in mean radiation risk (DAP Gy.cm^2) in 3/4 common procedures (one exclusion due to dissimilar cohort characteristics). Conclusions This study demonstrates employing a target maximum total image count limit reduced radiation exposure in trauma theatres.

Review of orthopaedic trauma surgery during the peak of COVID-19 pandemic – An observational cohort study in the UK

AimThis study aims to estimate the risk of acquiring medical complication or death from COVID-19 infection in patients who were admitted for orthopaedic trauma surgery during the peak and plateau of pandemic. Unlike other recently published studies, where patient-cohort included a more morbid group and cancer surgeries, we report on a group of patients who had limb surgery and were more akin to elective orthopaedic surgery. MethodsThe study included 214 patients who underwent orthopaedic trauma surgeries in the hospital between 12th March and 12th May-2020 when the pandemic was on the rise in the United Kingdom. Data was collected on demographic profile including comorbidities, ASA grade, COVID-19 testing, type of procedures and any readmissions, complications or mortality due to COVID-19. ResultsThere were 7.9% readmissions and 52.9% of it was for respiratory complications. Only one patient had positive COVID-19 test during readmission. 30-day mortality for trauma surgeries was 0% if hip fractures were excluded and 2.8% in all patients. All the mortalities were for proximal femur fracture surgeries and between ASA Grade 3 and 4 or in patients above the age of 70 years. ConclusionThis study suggests that presence of COVID-19 virus in the community and hospital did not adversely affect the outcome of orthopaedic trauma surgeries or lead to excess mortality or readmissions in patients undergoing limb trauma surgery. The findings also support resumption of elective orthopaedic surgeries with appropriate risk stratification, patient optimization and with adequate infrastructural support amidst the recovery phase of the pandemic.

Finite element analysis of biomechanical effects of residual varus/valgus malunion after femoral fracture on knee joint.

Post-operative femoral shaft fractures are often accompanied by a residual varus/valgus deformity, which can result in osteoarthritis in severe cases. The purpose of this study was to investigate the biomechanical effects of residual varus/valgus deformities after middle and lower femoral fracture on the stress distribution and contact area of knee joint. Thin-slice CT scanning of lower extremities and MRI imaging of knee joints were obtained from a healthy adult male to establish normal lower limb model (neutral position). Then, the models of 3°, 5°, and 10° of varus/valgus were established respectively by modifying middle and lower femur of normal model. To validate the modifying, a patient-specific model, whose BMI was same to former and had 10° of varus deformity of tibia, was built and simulated under the same boundary conditions. The contact area and maximum stress of modified models were similar to those of patient-specific model. The contact area and maximum stress of medial tibial cartilage in normal neutral position were 244.36 mm2 and 0.64MPa, while those of lateral were 196.25 mm2 and 0.76MPa. From 10° of valgus neutral position to 10° of varus, the contact area and maximum stress of medial tibial cartilage increased, and the lateral gradually decreased. The contact area and maximum stress of medial meniscus in normal neutral position were 110.91 mm2 and 3.24MPa, while those of lateral were 135.83 mm2 and 3.45MPa. The maximum stress of medial tibia subchondral bone in normal neutral position was 1.47MPa, while that of lateral was 0.65MPa. The variation trend of medial/lateral meniscus and subchondral bone was consistent with that of tibial plateau cartilage in the contact area and maximum stress. This study suggested that varus/valgus deformity of femur had an obvious effect on the contact area and stress distribution of knee joint, providing biomechanical evidence and deepening understanding when performing orthopedic trauma surgery or surgical correction of the already existing varus/valgus deformity.

Enhancing Preoperative Planning in Orthopedic Trauma Surgery Using a Presentation Software.

Preoperative planning (PP) is critical to ensure a successful outcome in orthopaedic trauma surgery. Since it was first described thirty years ago, no modifications have been made to the original preoperative planning (OPP) technique, which was written by hand using pen and paper. We believe that the use of presentation software (such as Microsoft PowerPoint, Microsoft Corp., Redmond, WA, US) can ease, improve and update the OPP and complement three-dimensional PP. The objective of the present paper is to describe our method for PP using a presentation software (PS).

Interobserver variability of injury severity assessment in polytrauma patients: does the anatomical region play a role?

BackgroundThe Abbreviated Injury Scale (AIS) and Injury Severity Score (ISS) are widely used to assess trauma patients. In this study, the interobserver variability of the injury severity assessment for severely injured patients was analyzed based on different injured anatomical regions, and the various demographic backgrounds of the observers.MethodsA standardized questionnaire was presented to surgical experts and participants of clinical polytrauma courses. It contained medical information and initial X-rays/CT-scans of 10 cases of severely injured patients. Participants estimated the severity of each injury based on the AIS. Interobserver variability for the AIS, ISS, and New Injury Severity Score (NISS) was calculated by employing the statistical method of Krippendorff's α coefficient.ResultsOverall, 54 participants were included. The major contributing medical specialties were orthopedic trauma surgery (N = 36, 67%) and general surgery (N = 13, 24%). The measured interobserver variability in the assessment of the overall injury severity was high (α ISS: 0.33 / α NISS: 0.23). Moreover, there were differences in the interobserver variability of the maximum AIS (MAIS) depending on the anatomical region: αhead and neck: 0.06, αthorax: 0.45, αabdomen: 0.27 and αextremities: 0.55.ConclusionsInterobserver agreement concerning injury severity assessment appears to be low among clinicians. We also noted marked differences in variability according to injury anatomy. The study shows that the assessment of injury severity is also highly variable between experts in the field. This implies the need for appropriate education to improve the accuracy of trauma evaluation in the respective trauma registries.

Intraoperative Computed Tomography in Orthopaedic Trauma Surgery.

When using mobile 3D C-arms, impairments in image quality occur due to artefacts caused by metal implants as well as to the limited field of view. To avoid these restrictions, special computed tomography devices were designed, in order to improve image quality and to meet requirements for intraoperative usage. To analyse practicability and benefits of a mobile intraoperative CT device (Airo, Brainlab, Munich, Germany) on the basis of several parameters that were obtained during a 40-month period. All procedures that were performed with usage of intraoperative CT between January 2017 and April 2020 were analysed with respect to anatomical region, count of scans, duration of scans, consequences drawn from the scans and use of navigation. 354 CT-scans were performed in 171 patients (mean 2.07 [1 - 6] scans per procedure). 47.81% of the procedures were spinal, 52.19% affected the pelvis. 83% of the procedures were navigated. In 22% of patients, improvement in implant placement or reduction was achieved; in most patients (55%), a guidewire for pedicle screws was corrected. The mean scan duration was 10.33 s (3.54 - 21.72). Use of intraoperative CT was reliable and helpful. Integration in OR standards requires more effort than mobile 3D C-arms. Image quality was outstanding for intraoperative conditions and allowed proper assessment of implant placement and reduction in all cases. Due to the high financial outlay of the system and the good image quality of 3D C-arms in the extremities, we assume that this procedure can be applied in intraoperative CT in traumatological cases in spinal and pelvic surgery in high-level trauma centres.

P36 Consent for Orthopaedic Trauma Surgery during the COVID-19 Pandemic

Surgical services have been hugely disrupted by COVID-19 and have had to evolve rapidly in response. The best practice for consent mandates that risks associated with surgical treatment during a pandemic be discussed. This study aimed to assess whether patients undergoing orthopaedic operations were being consented for the risk of contacting COVID-19 and ITU care.All orthopaedic consent forms from four-week periods in March, June and July were reviewed. Measures such as staff education were implemented after the second cycle.Of consent forms for 37 operations performed in March, only 1 mentioned the risk of contracting COVID-19 and zero mentioned ITU. During June, 89 consent forms were reviewed, 32 mentioned COVID-19 and 10 discussed ITU admission. Following educational measures, the third cycle showed a significant improvement as of 100 consent form records available for review, 73 included risk of COVID-19 whilst 26 mentioned ITU.The results show that earlier in the pandemic, surgeons at our centre were not counselling patients regarding COVID-19. This improved slightly between the first and second cycles, likely reflecting increased awareness of the nosocomial transmission of COVID-19. Educational measures contributed to a significant improvement in the third cycle. Planned interventions include use of electronic consent forms which incorporate COVID-19 infection and associated risks.

Outcomes of surgical management regarding acetabular fractures: cases from African countries.

The management of acetabular fractures, which are severe injuries and often complex, is difficult and costly especially for poor and developing African countries. To analyze and evaluate the functional and the radiological outcome of patients with acetabular fracture treated with open reduction and internal fixation. It is a retrospective study on 24 patients treated with ORIF and followed up in the Trauma Orthopedic Surgery Department of the Military Hospital of Moulay Ismail of Meknès (MHMIM) between January 2014 and December 2019. The average follow-up duration was 35 months (range: 9-81 months). The functional and radiographic outcomes and complication were considered as the main facts in this study. Twenty-four patients (male: 18, female: 6) with average age 38 years (range: 16 to 65 years) were operated for acetabular fracture. With Matta criteria use for assessing the radiological outcomes, the anatomical and good reduction was achieved in 79.1% of the patients. The functional results based on the modified Merle d'Aubigne and Postel criteria were judged excellent in 70.83%. Postoperative complications of acetabular fracture such as heterotopic ossification were found in 16%, post-traumatic arthritis in 20%, and avascular necrosis in 12.5% of patients. As there is a strong correlation between anatomic reduction and clinical outcome, the ORIF constitutes an effective method for treatment of displaced acetabular fracture in young aged patients who are considered as the most vulnerable categories in our continent.

Prevention and Treatment of Deep Vein Thrombosis of the Lower Limbs in Patients with Complications after Orthopedic Trauma Surgery

Objective: To explore and analyze on how to prevent and treat deep vein thrombosis of the lower limbs in patients with complications after orthopedic trauma surgery. Methods: The research patients were selected from the cases of surgical treatment of orthopedic trauma in the hospital during the past two years, and a total of 58 patients were selected. The patients were randomly divided into two groups, with 29 patients in the control group treated with conventional clinical methods; and the other 29 patients were assigned to the experimental group, where targeted preventive and therapeutic measures were administered. During the research, the number of complications of postoperative deep vein thrombosis of the lower limbs and the corresponding treatment efficacy were compared between the two groups of patients. Results: According to the results of clinical experiments, the probability of patients in the experimental group suffering from deep vein thrombosis of the lower limbs after surgery was significantly lower than that of the control group (P<0.05); in addition, when complications of deep venous thrombosis of the lower limbs occurred, the treatment efficacy of the patients in the experimental group was 96.55%, and the treatment efficacy of the patients in the control group was 82.76%. There was a significant difference between the two groups (P<0.05). Conclusion: Through clinical experiments to study and analyze the prevention and treatment measures of deep vein thrombosis in patients with complications after orthopedic trauma surgery, this research proves that active and comprehensive preventive and treatment measures can effectively reduce the number of complications and improve surgery treatment efficacy.

The effect of the orthopaedic trauma association's (OTA) pain management guidelines on opioid prescriptions, pain control, and refills in outpatient orthopaedic trauma surgery.

To determine the effect of the Orthopaedic Trauma Association (OTA) pain management guidelines for acute musculoskeletal injuries on opioid prescription sizes, pain control, and refills. A prospective cohort study was performed at an academic urban level 1 trauma center. 90 patients undergoing outpatient orthopaedic trauma surgery were enrolled before and after the implementation of the OTA pain management guidelines. Adherence to guidelines, pain visual analog scale, and refills were recorded postoperatively and at the 2- and 6-week follow-up visit. After implementation of the guidelines, the number of patients receiving oxycodone decreased from 100 to 27%, with these patients receiving the less potent hydrocodone, instead. The discharge morphine equivalent dose (MED) decreased from a median (interquartile range) of 225 (169-300) to 140mg (140-210) (p < 0.001). More patients required refills in the guidelines group (42% vs. 20%), resulting in no difference in total MED prescribed (210 (140-280) vs. 225 (169-307)). Adherence to the guidelines occurred in 66% of patients. As-treated analysis of patients with adherent and non-adherent prescriptions found no detectable difference in pain control, number of opioid pills used, or refills at the 2-week and 6-week follow-up. In the midst of a national opioid crisis, adoption of the OTA's pain management guidelines for orthopaedic trauma surgery warrants further research to determine if it's implementation can reduce the size, variability, and duration of opioid prescriptions. Level II, prospective cohort.

Wound care practices after orthopaedic trauma surgery are highly variable and not evidence based

ObjectiveGiven the tremendous medical, social and financial costs of surgical site infections, the pressure to minimize these complications has been mounting. There remains a substantial gap in evidence-based practice for postoperative wound care after orthopaedic trauma surgery. The purpose of this study is to determine what standards are currently in practice for postoperative wound management. MethodsA 16-question web-based survey was published on the Orthopaedic Trauma Association website and disseminated to members through the association's quarterly email. The survey gathered data on postoperative wound care practices; specifically, when wound checks are performed, and when providers allow patients to get the incisions wet. Results102 Orthopaedic surgeons completed the survey. Ninety-one percent were trauma fellowship trained, and 95% worked at either a Level I (76%) or Level II (19%) trauma center. There were over 100 different proposed protocols captured by the survey. The majority of surgeons (54%) perform a wound check within the first three days after surgery. Additionally, half of surgeons (50%) do not permit patients to get their incisions wet until sutures and staples are removed. ConclusionWound care routines following surgical management of orthopaedic trauma injuries are highly variable. Diverse protocols are performed at the discretion of the treating surgeon without scientific basis. This study defines immense variability in one aspect of peri-operative care that could play an important role in surgical site infections and provides a foundation for future studies to explore the potential influence of standardized wound care routines on post-operative infections and wound healing.

The hidden impact of rapid spread of the COVID-19 pandemic in professional, financial, and psychosocial health of Latin American orthopedic trauma surgeons.

ObjectiveTo assess the quality of life of Latin American orthopedic trauma surgeons during the beginning of COVID-19 pandemic in Latin America.MethodsA total of 400 orthopedic trauma surgeons from 14 Latin American countries were invited to complete an electronic survey aiming to understand the general situation of COVID-19 in each country and how COVID-19 had impacted life's participant financially and psychosocially. The relationship between the occurrence of the disease and the existence of legal regulations on the medical activity in the respondent's country, protocols for tracking the disease among patients hospitalized in an emergency basis due to skeletal trauma, and personal protective equipment to deal with patients diagnosed with COVID-19 who need orthopedic trauma surgery was investigated, as well as the financial and psychosocial impact caused by the disease. Data was statistically analyzed with significance p < 0.05.Results220 respondents completed the survey. 21 respondents were diagnosed with COVID-19. Local regulation was decisive in terms of increasing the risk for COVID-19 disease (p = 0.001). 91.8% of the respondents reported being concerned about their financial health and 57.7% described a state of feeling emotionally overextended. 75.0% believe that pandemic can change their professional activity.ConclusionThe rapid spread of the COVID-19 pandemic in Latin America has negatively impacted the professional, financial, and psychosocial health of orthopedic trauma surgeons. It seems reasonable to state that the combination of psychosocial distress and deprivation together with financial uncertainty and decreased revenue can be straightly related to development of burnout symptoms among doctors.

Clinical Faceoff: The Complex Tibial Plafond Fracture: ORIF or Circular External Fixation?

Clinical Faceoff: The Complex Tibial Plafond Fracture: ORIF or Circular External Fixation?