Table 1.

Recommendations for the treatment of COVID and non-COVID patients with fractures requiring surgical fixation

Avoid non-urgent surgeries and consultations, in order to limit people movement as the strict necessary

Create a dedicated operatory room for the treatment of positive and suspected COVID, training personnel to respect safely the dressing and undressing procedures

Create a dedicated ward and a dedicated area in the ICU to manage positive or suspected COVID, in order to limit the exposure of negative patients and staff.

Provide safety equipment, especially ffp2 masks, for all personnel involved in direct contact with positive or suspected COVID patients in operatory room, ward and ICU. Ffp2 masks should be used also in regular operatory rooms, because of possible surgeons and anesthesiologists to direct contact with asymptomatic carriers or false negative patients.

Re-organize medical and nurse staff within the regular wards and the COVID wards, providing an Internal Medicine doctor and Anesthesiologist consultants.

Use high suspicion in patients with fever and respiratory symptoms, especially in elderly, since false-negative tests could be present, even multiple; those patients should be managed as COVID unless diagnosis is ruled out (e.g., positive course of symptoms, response to non-COVID therapies, follow-up imaging…).

If COVID diagnosis is ruled out, consider moving patients in the normal ward to facilitate their management and not occupy vital space for positive COVID patients.

Discharge positive or suspected COVID patients as soon as possible to COVID-hospitals with dedicated ICU.

Consider implementing a pathway for positive or suspect COVID patients with no or few symptoms to allow wound management and physiotherapy in respect of isolation measures, wherever they are.

Maintain a human relationship with patients and their relatives.

Consider screening of healthcare personnel in order to identify and isolate asymptomatic carriers, especially in the case of contact with COVID patients without adequate protections.

Consider performing screening tests for any patients admitted to hospital and scheduled for surgery, and also before their discharge or transfer to other non-COVID structures.