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. 2020 May 15;1-8.
doi: 10.1007/s00264-020-04606-w. Online ahead of print.

Time-sensitive Ambulatory Orthopaedic Soft-Tissue Surgery Paradigms During the COVID-19 Pandemic

Free PMC article

Time-sensitive Ambulatory Orthopaedic Soft-Tissue Surgery Paradigms During the COVID-19 Pandemic

Benjamin Tze Keong Ding et al. Int Orthop. .
Free PMC article


Purpose: Timing of surgery for orthopaedic injuries continues to evolve, as an improved understanding of biology, healing, and technological advances continues to challenge historical norms. With the growing COVID-19 pandemic stretching limited healthcare resources, postponing surgery becomes an inevitable and unenviable task for most orthopaedic surgeons, and a shift in outpatient paradigms is required to mitigate poor outcomes in patients.

Methods: A scoping review of five databases on surgical timing and orthopaedic soft-tissue injuries was performed. All randomized controlled trials, longitudinal cohort studies, retrospective case series, systematic reviews, meta-analyses, and expert opinions were included for review, with 65 studies meeting the inclusion criteria.

Results: Better outcomes appear to be associated with early surgery for subluxations (< 1 week), recurrent dislocations (> 2 episodes), ligamentous and tendinous injuries (< 2 weeks), and bony avulsion injuries (< 3 weeks). Spinal conditions with neurological compromise should be operated on within 24 hours and spinal instability within 72 hours to reduce the risk of complications and poor outcomes.

Conclusion: Most soft-tissue orthopaedic injuries can be managed with outpatient ambulatory surgery in a semi-elective setting. As the paradigm for outpatient surgery shifts due to technological advances and the COVID-19 pandemic, it is critical for surgeons to time their surgery appropriately to maintain the high standards of orthopaedic practice.

Keywords: COVID-19; Delayed surgery; Orthopaedics; Pandemic; Surgery.

Conflict of interest statement

The authors declare that they have no conflict of interest.

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