Lessons From the Pandemic for Hand Surgery in Wales.

Aims In March 2020 the World Health Organisation (WHO) declared the COVID-19 virus a global pandemic. The United Kingdom's National Health Service (NHS) was placed under unprecedented pressure and hospitals were forced to adapt their working practices to continue offering world-leading healthcare. This project aims to highlight the lessons learnt within hand surgical departments throughout Wales. Using this knowledge, we can consider how these lessons can be implemented in both emergency and elective hand practice. Methods A qualitative questionnaire was distributed to hand consultants working across Health Boards within Wales during the pandemic. The questionnaire encompasses the impact of the pandemic on usual practices and what local departmental changes have been implemented in response to patient needs. Results Across the Welsh Health Boards, we received 12 of 19 consultant responses achieving a 63% response rate and captured data from five of seven (71%) major health boards. The questionnaire revealed that 100% of respondents changed their routine management of elective cases whilst 83% changed their management of hand trauma. 50% reported the need to issue updated management guidelines to junior doctors. The major highlighted lessons were the importance of a dedicated hand fracture clinic, coupled with a ring-fenced day-surgical unit (offering regional anaesthetic support) to manage trauma and elective patients independently from general trauma. Conclusion This qualitative research demonstrates that the pandemic drove the restructuring of many hand departments enabling us to find new, efficient ways of working. We must take these lessons forward to tackle the ever-growing waiting list, increased patient expectations and increasingly complex workloads.

A simple technique for intra-operative radiation protection in trauma and orthopaedic procedures.

With the number of orthopaedic surgical techniques using intra-operative radiological imaging, the need for effective methods of radiation protection is increasingly important. We describe a sterile, portable, easy to assemble method of providing adequate protection. This radiation protection shield is cost effective and can potentially reduce the risk of contamination and operating time.

Total hip replacement infected with Mycobacterium tuberculosis. A case report with review of literature.

Mycobacterium Tuberculosis infection of a total joint prosthesis in patients with previous pulmonary or osteoarticular tuberculosis is well recorded in literature. We describe the case of a 59-year-old woman with tuberculous infection complicating a total hip arthroplasty 15 months after surgery for osteoarthritis. The patient had no prior history of exposure to tuberculosis and no evidence of pulmonary or osteoarticular tuberculosis. She was treated with four-drug antituberculous chemotherapy for 12 months with retention of the prosthesis. The purpose of this case report and literature review is to highlight to the Western Orthopaedic surgeon the importance of keeping in mind a differential diagnosis of tuberculosis while dealing with prosthetic joint infections. The infection of a joint with Mycobacterium Tuberculosis in patients without previous tuberculosis is very uncommon. We have reviewed the surgical and medical management of the cases reported in literature.