LAUSR

The SARS-CoV-2 pandemic has led to worldwide crisis (from the Greek krisis used by Hippocrates and Galen as the “turning point of a disease when an important change takes place, indicating recovery or death”). In this crisis, the medical profession paid a high tribute to the pandemic with lethal cases and major stress exposure for the healthcare personnel [1]. Physicians in the front-line such as internists and anesthesiologists were mostly at risk, not simply of getting infected but of getting the infection in its most severe form. Orthopaedic surgeons were not in the front-line; however, they were definitely affected by the pandemic. Being an orthopaedic surgeon is a complex task that became more subtle and difficult in crisis; in the most affected countries, orthopaedic surgeons were urged to work outside their specific areas of training and expertise [2–4]. The SARS-CoV-2 pandemic impacted deeply the orthopaedic facilities worldwide [5, 6]. Clinical practice changed with fewer patients seen in all health systems. Surgical practice changed as well; elective operations were cancelled, and non-urgent operations were suspended, with a resultant substantial revenue loss for hospitals and surgeons. Surgery was mostly reserved for trauma and life-threatening conditions such as cancer, bone and soft-tissue sarcomas, or severe infections. Additionally, in times of pandemic, most surgeons did not want to operate, and many admitted to change management to non-operative for certain fractures. This was due to the hazards of poor protection and testing including the inability of routine checks on patients, lack of personal protective equipment, poor subsequent psychology for the risk of getting infected, and increased stress of going to the emergency room for non-urgent things. During the pandemic, we were told that standard surgical face masks do not provide sufficient protection; FFP2 and FFP3 face masks are more protective but they were not available from the start, as well as they were reserved only for front-line infectious diseases specialists. Cancellation of elective surgical operations led to a significant financial loss for the orthopaedic physicians, an increased backlog of numerus orthopaedic operations and substantial waiting list for the patients, and a significant reduction of the number of procedures for residents and trainees. Reassignment of trainees to high-volume institutions in the future may be a plausible approach to mitigate significant training deficits in the trainees worst impacted by the reduction in operative case volume [1–4, 7–13]. Orthopaedic surgeons’ incomes changed during COVID19 pandemic [10, 14, 15]. The rapidly spreading threat imposed an unprecedented burden on the effectiveness and sustainability of the healthcare systems. The COVID19 pandemic led to an overall increase in visits to clinical emergency and hospitalization numbers, and cancellation of elective surgery and clinical appointments that impacted the financial incomes of the medical practitioners. According to a survey of 975 orthopaedic surgeons in Brazil, approximately 98% of them suffered some monetary impact; 80% had a financial reserve from which 45% could last for three months. Longer the time of professional experience, greater the reduction percentage of the monthly income [14]. An alternative for replacing loss of activity and face-toface clinics is the virtual consultation. Telemedicine has been used in some countries to deliver orthopaedic care to patients remotely. It is a useful technique for offering advice on for patients’ care, pain control, and rehabilitation. However, although it might work for a tendinitis or carpal tunnel syndrome, it cannot be useful if the patient has a fracture. It is our opinion that the use of telemedicine will continue in the post-pandemic era; yet, telemedicine may facilitate the * Marius M. Scarlat [email protected]