An Orthopaedic Dispatch from Iran

By definition, a pandemic is a global public health crisis. Consequently, along with reports from North American orthopaedists, JBJS fast-tracked COVID-19 coverage has included data from Singapore, China, Italy, and Portugal. The most recent report, authored by Askari et al., comes from Iran.

Iran announced its first report of COVID-19 on February 19, 2020. As of April 21, 2020, the country had >83,505 documented cases, and the Iranian Ministry of Health (MoH) had reported at least 3,739 deaths from the virus.

Two weeks after the detection of the first COVID-19 cases in Iran, the MoH sent an official letter to all health-care centers—governmental and private—to stop all elective surgeries. Some private-sector hospitals obtained permission to restart elective surgeries, but orthopaedic departments at all governmental healthcare centers saw and treated only trauma patients. Ironically, with self-quarantining in Iran, the number of traffic-related trauma cases has decreased because fewer people are commuting.

Within 1 month after the first official reports of COVID-19 in Iran, most private-sector hospitals completely stopped all their surgeries, and some started seeing patients online. All empty hospital beds were designated for the treatment of patients with COVID-19.

While most orthopaedic surgeons were sidelined from the operating room, the Iranian Orthopaedic Society (IOS) and its branches created multiple social media groups to maintain an open channel for the exchange of scientific ideas and to promote orthopaedic research. Meanwhile, orthopaedic residents, somewhat demoralized because of the cancellation of classes and hospital grand rounds, maintained a level of practical education through trauma surgeries and seeing patients in the emergency department.

The Iran University of Medical Sciences in Tehran is now holding online orthopaedic webinars to maintain orthopaedic education for residents and to exchange up-to-date information regarding COVID-19. In addition, the IOS and its subspecialty divisions have further maintained their case studies using e-learning platforms. However, there are large disparities across the country and among universities in the development and implementation of distance-learning programs.

Overall, Askari et al. concur with orthopaedic surgeons elsewhere in the world that the pandemic has shown that the role of orthopaedists can—and at times must—go far beyond “only tending to fractures.”

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