The covid-19 pandemic is in our midst. As should be expected, the surgical branches have been relegated to relative obscurity for the time being. Amongst these branches is the science of orthopaedics [1].
Even as the number of cases crosses one million, is there a silver lining in this doom and gloom from the orthopaedic perspective?
Probably none. However, this pandemic does provide the orthopaedic surgeons a chance to reassess the conservative management of trauma in orthopaedics.
Guidelines have emerged that elective surgeries should be postponed. Overwork should be limited [2]. There are also guidelines that suggest that conservative management of some fractures, at least, should be used as a definitive method. The British Orthopaedic Association in its clinical guidelines suggests that clinical decisions must look at the facilities available to carry out the said decisions. It also mentions that there will be shift towards non-operative treatment [3]. This is especially so because of the mechanisation of surgical intervention due to technology. This has potential to create aerosols which can be dangerous under the current circumstances quite apart from the risk to the anaesthetist.
Dr Sarmiento in his article in 2008 has commented on relatively irrational bias against conservative management of fractures. He mentions that one of his trainees was blunt enough to tell him that his only concern was fixation of the fracture not the process of healing. He has also flagged the concern that profit might be becoming the raison d'etre [4]. The debates might keep raging around this topic but this natural calamity might just provide an opportunity to ‘cleanse the system’ [5].
However as the world begins to question its readiness for pandemics and mass disasters, the orthopaedic community has to assess how it might define and develop its own preparation for future challenges.
A central part of that preparedness is the ability to deliver quality fracture treatment under relatively extreme conditions and conservative fracture care. In the pursuit of this goal two points that need to be stressed naturally.
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1
Making our trainees and residents understand the value and importance of conservative fracture management. This should include assessment and evaluation of the literature regarding conservative methods, which have also evolved over a period of time albeit unnoticed.
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2
Having rigorous hands on training in conservative methods. It is an unstated truth that the art of conservative management has more gardening involved whilst surgical intervention is more akin to carpentry. Gardening needs a bit more patience.
The prescription for self knowledge, integrity, objectivity and the pursuit of greater understanding could very well lead to greater preparedness. It is time to revive Socrates [4].
Declaration of Competing Interest
There is no conflict of interest in the formulation of this manuscript
References
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