CMCH’s protocol shields orthopaedic care team from Covid

COIMBATORE: Orthopaedic care at Coimbatore Medical College Hospital (CMCH) did not take a beating so far despite the pandemic, thanks to a protocol implemented by the hospital. In 2020, the Institute of Orthopaedics and Traumatology launched 'Coimbatore orthopaedic surgical fixation protocol in Covid-19 pandemic' to attend to emergency and closed fracture cases. Doctors said by putting in place the protocol, none of healthcare workers in the orthopaedic operation theatre tested positive even as few staff in Covid-19 wards tested positive. All the staff in the orthopaedic section were instructed to wear PPE kits, double gloves, goggles and masks, the doctors added.

245 successful surgeries

A study published by CMCH doctors in the ‘Journal of Orthopedics and Joint Surgery’ said the protocol is useful not only in early identification and segregation of infected patients but also in prioritising surgeries . Director of the Institute S Vetrivel Chezian said there was no protocol orthopaedic surgeons except using personal protective gadgets in the early phase of the pandemic.  "Many private hospitals were reluctant to take up orthopaedic surgeries and government tertiary care centres were the last resort for patients. We came up with a protocol to handle compound and closed fractures," he asaid adding 245 surgeries were performed between April and December 2020.

The procedure

Vetrivel said all orthopaedic patients admitted to the emergency ward were subjected to RT-PCR test, Cartridge Based Nucleic Acid Amplification Test (CBNAAT) assay, and CT chest for Covid-19 Reporting and Data System (CO-RADS) to rule out the involvement of lung due to the viral infection.

Based on the outcome of the result, positive cases with compound fractures were operated in designated operation theatre, and the negative ones with compound fractures were operated in the emergency orthopaedic theatres. Covid-19 positive patients with closed fractures were transferred to the special ward for treatment.

He added, "Once patients tested negative, they were transferred back to the orthopaedic ward where they were screened again 24 hours before surgery. The protocol is still being followed even though fresh Covid-19 cases have come down."  The study was presented in Tamil Nadu Orthopedia State Conference held in Salem recently and could serve as a model for other hospitals to emulate.