Safety protocols for patients with both respiratory and contact isolation are already known by the health workers, especially for those who work in the Operating Room. The wide use of those protocols meets the need of an extraordinary contingency, such as a global pandemic. An invisible enemy, difficult to individuate, makes every health worker afraid of the contagion and for this reason also doubtful on the predisposed safety measures.
Due to the nature of this health crisis, orthopedic surgeons were not the most involved health workers in this pandemic outbreak, however they have shown a great capacity of adaptation and solidarity, both helping colleagues in the management of patients in the E.R. [15] and converting their own activity to help the National Healthcare System [16]. The interruption of elective surgery deeply changed the orthopedic surgeon’s daily routine to allow the hospital to stay focused on those patients, who needed urgent healthcare [17]. As concerns the future of our profession, since we have to deal with the virus, we need to rethink the care pathway within our structures and our services. Traumatological patients affected by SARS-CoV-2 had to be admitted to the Infectious diseases Unit, while waiting for surgery. This preventive measure was taken for their own safety and for the safety of the other traumatological patients, which were usually elderly and vulnerable.
Coronavirus revolutionized the way we approach clinical cases, pre-operative surgery and the surgery itself. We have to make our surgical decision not only on the basis of the traumatological evidence, but also considering the safety measures to minimize the contagion risk [18]
Orthopedics and Traumatology is a surgical branch that, by definition, has more risk factors for the contagion. Just consider the use of power tools, ultradrive and high-speed burr, determining an increased diffusion of blood in the surgical theatre [17, 19]. The use of Personal Protective Equipment (PPE) and the safety protocols for orthopedic surgeons have to be a priority.
In our experience, we were able to evidence, even if not with a wide casuistic, a good result according to the safety level reached in our unit. With no Covid-19 cases among the O.R. staff, our team stayed safe even facing directly the contagion in the surgical theatre. Patients affected by SARS-CoV-2 underwent surgery with the same quality and professional standard assured to other non-SARS-CoV-2 patients. Therefore, we reached our primary goal, defending their right to healthcare despite the situation.
In this regard, once the pandemic impact will decrease its force, we need to re-start thinking about patients who are waiting for elective surgery. Due to novel Coronavirus, already full waiting lists are going to see even more delays, with an increased discomfort for those patients. A fair balance between emergency surgery and elective surgery at the time of pandemic diseases has to be found.
At last, for a patient with confirmed or suspected SARS-CoV-2, with either clinical, sierological or virological positivity (even if they are not all found at the same time), we need to indicate safety measures in the O.R. since a reliable test with high sensitivity and specificity for SARS-CoV-2 is not available yet.