JBJS has already fast-tracked an article by Mi et al. about the best way to manage patients who have a bone fracture as well as COVID-19. The latest fast-tracked COVID-19 article from JBJS comes from Portuguese authors Rodrigues-Pinto et al. It provides an exquisitely detailed protocol for operating room set-ups and staff workflows when treating surgical patients who are COVID-19-positive, with an emphasis on the specifics required for trauma and orthopaedic surgery.
The authors describe a 5-zone operative complex, as shown in the Figure above. Most of the details from Rodrigues-Pinto et al. explain precautionary procedures to be taken in Zones 1 and 2 and Zones 3 and 4, areas preceding and following the operating room.
For Zone 3, the OR itself, the authors recommend a portable HEPA filtration system with a high frequency of air changes to rapidly reduce the viral load within the OR. Another in-the-OR tip for trauma and orthopaedic surgical procedures is to use power tools (such as electrocautery, bone saws, reamers, and drills) sparingly, and to set their power levels as low as possible. That’s because such tools release aerosols, which increase the risk of virus spread. Suction devices to remove smoke and aerosols should also be used during surgical procedures on COVID-19 patients.
Whats the rush? Unless there is a compartment syndrome or vascular injury, why not wait until two serial RNA probes are negative. It is what they did at the 2nd Peoples Hospital in Wenzhou China. Why rush? Let the lungs recover, let the patient declare themselves, and finally, protect the team.