Sir,
We read with great interest your insightful paper on the Italian experience with orthopaedic trauma surgery during COVID 19. The world has come to a standstill dealing with the COVID 19 pandemic holding the reign of attention. Various countries are at different stages of the pandemic progression and the most common administrative management is lockdown of cities and countries. Lockdowns, although the need of the hour to manage the current scenario, have a significant impact on health care access and management for patients dealing with other medical conditions.
In orthopaedics, we are managing the elective and emergency cases as per the country/institute guidelines in India. The biggest contribution to any healthcare system currently would be to offload avoidable patient burden. This not only optimizes resource utilization but also decreases the chances of spread of COVID 19 infection.
Amidst the spectrum of cases currently being addressed at our institute, a subset of cases that warrant attention are an increased number of fractures around the hip like neck of femur fracture, intertrochanteric fracture as well as distal end radius fracture in the elderly. We observed that although the accident cases decreased substantially during lockdown, there was a spike in fractures caused secondary to slipping. These patients are also seen to have increased risk of TMJ injuries and mandibular fractures secondary to slipping.
The surge in slipping incidents has been attributed to multiple issues. It includes the fact that most children are housebound and restricted from using playgrounds, therefore kids are playing indoors. Many of our patients reported tripping/slipping over kid toys, spilled food, water and wet bathroom floors.
We advise people to allot dedicated play areas for kids in houses and using anti-skid mats in bathrooms. All old people are advised to use assistive walking devices even within house premises. Since complete lockdowns have limited the physical activity and thereby people become restless, we advise them to engage in light walking, stretching activity within home premises but to strictly separate playing areas for kids from these walking areas.
We recommend forwarding this advice to all patients that contact health professionals during OPD and telemedicine contact.
Funding
None.
Declaration of Competing Interest
None.
Footnotes
This is to state that this manuscript is not under consideration or submitted anywhere else. Neither is part of this manuscript overlapping with any other submission.