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      Orthopedic Surgery and Telemedicine in Times of COVID-19 and Beyond: a Review

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          Abstract

          Purpose of Review

          This review article presents the current knowledge on the use of telemedicine and summarizes the literature highlighting the advantages and limitations of this technology in the field of orthopedic surgery during the COVID-19 pandemic and beyond.

          Recent Findings

          Orthopedic surgery is the surgical specialty that has seen the highest proportion of its procedures cancelled due to the pandemic. In this context and onward, telemedicine seems to be a reasonable option for the orthopedic surgeon. Multiple studies have described its safety and a similar patient satisfaction compared to in-person consultations. It has a potential to increase productivity and decrease wait times by providing easier access to the clinician and by decreasing travel-associated limitations and costs. Authors have described the possibility to conduct a reliable virtual assessment of the patient range of motion. Some of the limitations to the use of this technology are technological literacy and access to virtual consultation platforms, the inability to conduct a complete physical examination, potential reduction in identification of intimate and child abuse victims, and limited knowledge about the legal implications of this technology.

          Summary

          Telemedicine in orthopedic surgery has a potential to increase productivity, reduce costs, and increase the access to healthcare. Identified limitations include risk of misdiagnosis, required technologic literacy, unknown legal implications, and failure to identify victims of abuse. In order to use this technology judiciously, the clinician must take into consideration the patient’s condition and his technological literacy and be aware of the advantages and disadvantages.

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          Most cited references9

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          Survey of COVID-19 Disease Among Orthopaedic Surgeons in Wuhan, People’s Republic of China

          Background: Coronavirus disease 2019 (COVID-19) broke out in Wuhan, the People’s Republic of China, in December 2019 and now is a pandemic all around the world. Some orthopaedic surgeons in Wuhan were infected with COVID-19. Methods: We conducted a survey to identify the orthopaedic surgeons who were infected with COVID-19 in Wuhan. A self-administered questionnaire was distributed to collect information such as social demographic variables, clinical manifestations, exposure history, awareness of the outbreak, infection control training provided by hospitals, and individual protection practices. To further explore the possible risk factors at the individual level, a 1:2 matched case-control study was conducted. Results: A total of 26 orthopaedic surgeons from 8 hospitals in Wuhan were identified as having COVID-19. The incidence in each hospital varied from 1.5% to 20.7%. The onset of symptoms was from January 13 to February 5, 2020, and peaked on January 23, 8 days prior to the peak of the public epidemic. The suspected sites of exposure were general wards (79.2%), public places at the hospital (20.8%), operating rooms (12.5%), the intensive care unit (4.2%), and the outpatient clinic (4.2%). There was transmission from these doctors to others in 25% of cases, including to family members (20.8%), to colleagues (4.2%), to patients (4.2%), and to friends (4.2%). Participation in real-time training on prevention measures was found to have a protective effect against COVID-19 (odds ratio [OR], 0.12). Not wearing an N95 respirator was found to be a risk factor (OR, 5.20 [95% confidence interval (CI), 1.09 to 25.00]). Wearing respirators or masks all of the time was found to be protective (OR, 0.15). Severe fatigue was found to be a risk factor (OR, 4 [95% CI, 1 to 16]) for infection with COVID-19. Conclusions: Orthopaedic surgeons are at risk during the COVID-19 pandemic. Common places of work could be contaminated. Orthopaedic surgeons have to be more vigilant and take more precautions to avoid infection with COVID-19. Level of Evidence: Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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            Quality of care for remote orthopaedic consultations using telemedicine: a randomised controlled trial

            Background Decentralised services using outreach clinics or modern technology are methods to reduce both patient transports and costs to the healthcare system. Telemedicine consultations via videoconference are one such modality. Before new technologies are implemented, it is important to investigate both the quality of care given and the economic impact from the use of this new technology. The aim of this clinical trial was to study the quality of planned remote orthopaedic consultations by help of videoconference. Method We performed a randomised controlled trial (RCT) with two parallel groups: video-assisted remote consultations at a regional medical centre (RMC) as an intervention versus standard consultation in the orthopaedic outpatient clinic at the University Hospital of North Norway (UNN) as a control. The participants were patients referred to or scheduled for a consultation at the orthopaedic outpatient clinic. The orthopaedic surgeons evaluated each consultation they performed by completing a questionnaire. The primary outcome measurement was the difference in the sum score calculated from this questionnaire, which was evaluated by the non-inferiority of the intervention group. The study design was based on the intention to treat principle. Ancillary analyses regarding complications, the number of consultations per patient, operations, patients who were referred again and the duration of consultations were performed. Results Four-hundred patients were web-based randomised. Of these, 199 (98 %) underwent remote consultation and 190 (95 %) underwent standard consultation. The primary outcome, the sum score of the specialist evaluation, was significantly lower (i.e. ‘better’) at UNN compared to RMC (1.72 versus 1.82, p = 0.0030). The 90 % confidence interval (CI) for the difference in score (0.05, 0.17) was within the non-inferiority margin. The orthopaedic surgeons involved evaluated 98 % of the video-assisted consultations as ‘good’ or ‘very good’. In the ancillary analyses, there was no significant difference between the two groups. Conclusions This study supports the argument that it is safe to offer video-assisted consultations for selected orthopaedic patients. We did not find any serious events related to the mode of consultation. Further assessments of the economic aspects and patient satisfaction are needed before we can recommend its wider application. Trial registration ClinicalTrials.gov identifier: NCT00616837 Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1717-7) contains supplementary material, which is available to authorized users.
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              Prospective randomized controlled trial using telemedicine for follow-ups in an orthopedic trauma population: a pilot study.

              To compare patient satisfaction between telemedicine and in-person follow-up appointments for orthopedic trauma.
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                Author and article information

                Contributors
                philippe.moisan@mail.mcgill.ca
                bardia.barimani@mail.mcgill.ca
                Journal
                Curr Rev Musculoskelet Med
                Curr Rev Musculoskelet Med
                Current Reviews in Musculoskeletal Medicine
                Springer US (New York )
                1935-973X
                1935-9748
                18 January 2021
                : 1-5
                Affiliations
                [1 ]GRID grid.63984.30, ISNI 0000 0000 9064 4811, Division of Orthopaedic Surgery, , McGill University Health Centre, ; 1650 Cedar Avenue, Montreal, Quebec H3G 1A4 Canada
                [2 ]GRID grid.63984.30, ISNI 0000 0000 9064 4811, Division of Orthopaedic Surgery, , McGill University Health Centre, ; Jewish General Hospital, Montreal, Quebec Canada
                Author information
                http://orcid.org/0000-0002-3607-148X
                Article
                9693
                10.1007/s12178-021-09693-9
                7812031
                33460020
                0e50f7b9-ee20-494e-b895-b647cb0dbaca
                © The Author(s), under exclusive licence to Springer Science+Business Media, LLC part of Springer Nature 2021

                This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

                History
                : 8 January 2021
                Categories
                Hot Topics

                Orthopedics
                telemedicine,teleorthopedics,covid-19,virtual consultations,virtual physical examination,orthopedic surgery

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