Specialty and subspecialty guidance and resources during the COVID-19 pandemic
Below are links to guidance documents regarding coronavirus in the trauma and orthopaedic specialty and subspecialties.
NHS England specialty guides:
- Trauma and Orthopaedic surgery
- Spinal surgery
- Paediatrics (non-surgical)
- Perioperative care of fragility fracture patients
- Major trauma
- Urgent and Emergency Musculoskeletal Conditions Requiring Onward Referral
- Urgent and emergency musculoskeletal conditions in children (under 16) requiring onward referral
- Management of patients requiring transfer for specialist rehabilitation
National Guidance relevant to T&O:
- New guidance regarding adult MSK services
NHS England guidance entitled ‘Primary and community musculoskeletal adult services: Restoration principles’, which is badged by the BOA, was released on 20th August 2020.
The guidance is intended to support the restoration of services as part of the Third Phase NHS response to the Coronavirus pandemic, as well as reflecting the ambitions of the Long Term Plan. The guidance may be of interest to members as it discusses topics including patient referrals, MSK triage systems and secondary care support for primary care and community services. This guidance is currently being disseminated through various routes to reach regional and local teams, and is available here to download.
- NICE has published guidance on “Arranging planned care in hospitals and diagnostic services” (27 July 2020), which covers NHS arrangements for patients needing elective surgery and other planned treatments and procedures (including diagnostics and imaging). There are some significant changes to practice regarding testing, self-isolation prior to surgery and also an emphasis on shared decision making. The full document is available here and a short one-page version is here.
- Elective surgery restart and paediatric patients
The Royal College of Paediatrics and Child Health has published important new national guidance for the recovery of elective surgery in children, which will be relevant to all those operating on children or involved in COVID-19 restart planning.. This guidance has been developed by the following organisations: NHS England, Public Health England, the Royal College of Surgeons of England, Royal College of Anaesthesia, Royal College of Paediatrics and Child Health, the Children’s Surgical Forum, British Association of Paediatric Surgeons, Association of Paediatric Anaesthetists of Great Britain and Ireland, and The Association for Perioperative Practice. It is available online here.
BOA and Specialist Society documents:
COVID BOASTs (cobadged by OTS, BSCOS, BSSH and BAHT)
BSCOS have compiled a page of resources, from a wide number of organisations, to help during the COVID-19 pandemic. The page with all resources can be found here.
BSSH have a resource page for members here.
Charnley's Closed Treatment of Common Fractures
The name Charnley is forever linked with hip replacement but Sir John Charnley’s influence on Trauma and Orthopaedics extended well beyond arthroplasty. Before the term ORIF became so widespread in the notes of our fracture patients the mainstay of treatment was non-operative. His book ‘The Closed Treatment of Common Fractures’ was ubiquitous, its blue jacket visible on virtually every surgeon’s bookshelf. It isn’t just a recipe book but is full of explanation and rationale. I copied the simple wooden model he used to demonstrate and teach how to reduce a fracture and still use it to lecture the unwary who do not remember to reverse the mechanism of the injury.
As time has passed the operative treatment of fractures has become commonplace and the confidence and skills required to manage them non-operatively have diminished. Now in the midst of the Coronavirus crisis we must manage our patients without competing for those resources vital for the patients needing respiratory support. We will have to revise and regain some lost skills of non-operative care. The Sir John Charnley Trust have generously made ‘The Closed Treatment of Common Fractures’ available as open access and is available here. It is a great resource both as a repository of the lost skills we may now need and also a chronicle of a period of fracture treatment in the UK. Whilst this book is open access you may feel it appropriate having used it to make a donation to the Charnley Trust.