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Orthopaedic surgeons should focus on postponing elective surgeries and adopt alternative treatments

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Dr Parag Sancheti, an orthopaedic surgeon and Managing Director of Sancheti Institue of Orthopedics and Rehabilitation, Pune outlines briefly how surgeons can tackle trauma cases and  other elective surgeries during COVID times

Orthopaedic surgeries have been greatly impacted by the emergence of COVID -19 in India. It then becomes important to understand the challenges and solutions for orthopaedic surgeons in India while dealing with patients during the COVID – 19 pandemic.

In an orthopaedic hospital, the majority of the work comes from elective surgeries. Like for example, in Sancheti Hospital from Pune, 50 to 70 per cent is elective work. For elective surgeries, it is mostly done as per the convenience of the surgeon and the patient. While all the emergency orthopaedic surgeries need to be done immediately, elective surgeries can be postponed.

During the current pandemic situation, we have dropped many elective surgeries and we are postponing them. Mainly only 20 to 25 per cent of elective surgeries are what we are doing from the entire elective surgeries that we would have otherwise done. Emergency cases have also reduced, but slowly they are taking up.

Patients for elective surgeries have dropped and they are hesitant to come to the hospital. Also, I would advise that elective surgeries can be avoided if the ailment is such that patients can wait.

As we are postponing elective surgeries, will there be a big rise in workload at the end of six months from now? Well, I don’t anticipate a big rise at the end of say six months from now. Those people who really need to get it done are coming and getting it done. In fact, some patients who wanted to do it, but after waiting they found that they are getting used to with the pain and they can manage their life. So, these kinds of patients may not come for operations also. Patients will gradually increase and the number of cases as compared to what orthopaedic surgeons were doing in January and February this year. It will take time for us to reach to those kinds of number.

For trauma patients, we have to assume all the patients who come to the hospital are COVID positive. For trauma patients, first, we have to examine them,  give them first aid, immobilise them, take care of their pain, etc. While doing all these things we do not know if the patient is COVID positive or from the containment zone. Hence, we need to assume all trauma patients to be COVID positive and we need to treat them accordingly. We can take all the precautions like using PPE kit etc. Once the COVID results have come, we can be a little more relaxed if the test comes negative.

It is not compulsory for testing each and every new admission for COVID. If you suspect and if the patient has any symptoms then you must definitely test the patient for COVID. We at our hospital generally do not do COVID tests for all the patients. If the patient comes positive, you have to treat the patient with all the necessary precautions. While managing OPD’s, we must use PPE kits.

There are alternative management options or non-operative management. Whatever that can be done non-operatively like back pain, knee pain, neck pain; that trial should be given. This is the first option nowadays. If the conservative treatment options, after trying repeatedly does not work, then we may go for operative treatment.

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