Background: Open fractures form one of the most common musculoskeletal injuries and are often complicated by infection. In this unprecedented situation, the additional infection rates, further add to the burden of the already compromised healthcare setup. The present study is done to see the effect of COVID-19 on management of open fractures. Methods: A retrospective evaluation of patients with open fractures from March 25th , 2020 to July 21st , 2020 (group 1) and March 25th , 2019 to July 21st , 2019 (group 2) was performed. These patients were assessed for demographic details, diagnosis, type of surgery, delay from injury to admission, delay from admission to surgery, postoperative hospital stay, acute infection rates, readmission rates and associated injuries. Results: A total of 52 patients with 59 open fractures in 2020 and 89 patients with 101 open fractures in 2019 met the inclusion criteria. The mean age was 34.76 years and 32.74 years in 2020 and 2019 respectively. Road side accidents were predominant in both the groups, comprising of 38 (73.07%) and 67 (75.28%) respectively(n.s.); adult patients were 42 (80.76%) and 79 (88.76%) respectively(n.s.); paediatric patients were 10 (19.23%) and 10 (11.23%) respectively(n.s.); tibia was the most common bone involved, comprising of 14 (23.72%) and 27 (26.73%) open fractures respectively(n.s.); external fixator was the most commonly used implant during COVID-19 time with 42 (71.18%) and 51 (50.49%) respectively(p ¼ 0.005); the infection rate was 25.42% and 20.79% respectively(n.s.); the time for administration of first intravenous antibiotic dose was on 6.75 h and 4.04 h respectively(p < 0.0001); average time between the admission and surgical debridement was 24.04 h and 19.32 h respectively(n.s.); referral cases were 33 (63.46%) and 44 (49.43%) respectively(n.s.); re-admission rates were 7/52 (13.46%) and 10/89(11.23%) respectively(n.s.). Conclusion: Despite the decrease in total trauma cases, a delay in presentation to the emergency room/ administration of first dose of antibiotic and increase in temporary fixation in form of external fixator was observed. Further, an increase in infection rates, referral cases and readmission rates were observed, though not statistically significant.

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Wound irrigation is described as the flow of a solution through an exposed fracture surface to reduce the microbial colonization, to remove apparent foreign particles and wound exudates. . While recent literature and various in-vitro and in-vivo trials have cleared some clouds of doubt from the mind, it still remains a topic of debate. Normal saline remains the standard irrigation solution as it is non tissue toxic and has the same tonicity as body fluids. The quantity and duration of washing though is not standardized and is the surgeon's choice. This adds to the dilemma in the minds of the surgeon, with the timing of the debridement and the duration of wound irrigation depending on the surgeon's discretion. Future studies should aim to regulate the duration of the wound irrigation besides guiding about the ideal fluid volume to be used for the irrigation. Further, secondary end-points like the duration of hospital stay, rate of infections and use of hospital resources, should be computed to know about the adequacy of the wound debridement and irrigation. Antimicrobial solutions can kill microorganisms in the wound but are toxic to the host tissues as well, which limits their use. In addition, pulsatile (high pressure) lavage has not been seen to increase overall effectiveness. Recent research trials have found cumulative use of innovative solutions like phenols and EDTA along with enzymes to be encouraging though large randomized controlled trials are lacking.

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Objectives: The present study was conducted with the objective of identifying the cause of injuries in fast bowlers. Materials and Methods: The present study is a video analysis study, keywords such as “fast bowler’s injury,” “failure of bowling,” and “cricket injuries” were searched on YouTube. Bowling action was divided into four stages – Stage 1 – jump, Stage 2 – back foot contact, Stage 3 – front foot contact, and Stage 4 – follow-through. The type and timing of injury (stage) were noted after analyzing the videos. Results: Sixteen injuries were identified in five videos. It was observed that 15 athletes had acute injury to lower limb and 1 athlete had an acute injury to lower back. 13/16 injuries happened in Stage 2 and 3/16 injuries happened in Stage 4. Conclusion: Most of the injuries happened at the time of landing and follow-through. Therefore, improvement of ground conditions, especially around the bowling area, and addition of exercise-based injury prevention programs can reduce the risk of injuries. This is more important for young fast bowlers at the club levels and state levels, as proper training at an early stage, can prevent injuries in many young fast bowlers.