AbstractWith a lot of uncertainty, unclear, and frequently changing management protocols, COVID-19 has significantly impacted the orthopaedic surgical practice during this pandemic crisis. Surgeons around the world needed closed introspection, contemplation, and prospective consensual recommendations for safe surgical practice and prevention of viral contamination. One hundred orthopaedic surgeons from 50 countries were sent a Google online form with a questionnaire explicating protocols for admission, surgeries, discharge, follow-up, relevant information affecting their surgical practices, difficulties faced, and many more important issues that happened during and after the lockdown. Ten surgeons critically construed and interpreted the data to form rationale guidelines and recommendations. Of the total, hand and microsurgery surgeons (52%), trauma surgeons (32%), joint replacement surgeons (20%), and arthroscopy surgeons (14%) actively participated in the survey. Surgeons from national public health care/government college hospitals (44%) and private/semiprivate practitioners (54%) were involved in the study. Countries had lockdown started as early as January 3, 2020 with the implementation of partial or complete lifting of lockdown in few countries while writing this article. Surgeons (58%) did not stop their surgical practice or clinics but preferred only emergency cases during the lockdown. Most of the surgeons (49%) had three-fourths reduction in their total patients turn-up and the remaining cases were managed by conservative (54%) methods. There was a 50 to 75% reduction in the number of surgeries. Surgeons did perform emergency procedures without COVID-19 tests but preferred reverse transcription polymerase chain reaction (RT-PCR; 77%) and computed tomography (CT) scan chest (12%) tests for all elective surgical cases. Open fracture and emergency procedures (60%) and distal radius (55%) fractures were the most commonly performed surgeries. Surgeons preferred full personal protection equipment kits (69%) with a respirator (N95/FFP3), but in the case of unavailability, they used surgical masks and normal gowns. Regional/local anesthesia (70%) remained their choice for surgery to prevent the aerosolized risk of contaminations. Essential surgical follow-up with limited persons and visits was encouraged by 70% of the surgeons, whereas teleconsultation and telerehabilitation by 30% of the surgeons. Despite the protective equipment, one-third of the surgeons were afraid of getting infected and 56% feared of infecting their near and dear ones. Orthopaedic surgeons in private practice did face 50 to 75% financial loss and have to furlough 25% staff and 50% paramedical persons. Orthopaedics meetings were cancelled, and virtual meetings have become the preferred mode of sharing the knowledge and experiences avoiding human contacts. Staying at home, reading, and writing manuscripts became more interesting and an interesting lifestyle change is seen among the surgeons. Unanimously and without any doubt all accepted the fact that COVID-19 pandemic has reached an unprecedented level where personal hygiene, hand washing, social distancing, and safe surgical practices are the viable antidotes, and they have all slowly integrated these practices into their lives. Strict adherence to local authority recommendations and guidelines, uniform and standardized norms for admission, inpatient, and discharge, mandatory RT-PCR tests before surgery and in selective cases with CT scan chest, optimizing and regularizing the surgeries, avoiding and delaying nonemergency surgeries and follow-up protocols, use of teleconsultations cautiously, and working in close association with the World Health Organization and national health care systems will provide a conducive and safe working environment for orthopaedic surgeons and their fraternity and also will prevent the resurgence of COVID-19.

Introduction The superficial palmar arch is the main contributor to the vascular supply of the hand. Numerous anatomical variants have been described and there are multiple classifications of the superficial palmar arch available. The Kaplan cardinal line is used occasionally as a reference to identify the deep structures of the hand. However, there are also multiple variants of the line and multiple reports regarding the structures that can be identified with it. Material and Methods Ten anatomical dissections of hands were performed in seven cadaveric specimens. The anatomical variants of the superficial palmar arch were recorded, as well as their relationship with the Kaplan cardinal line. A review of the available literature was made. Results According to the classification by Coleman et al, the most common type was the complete superficial palmar arch, present in seven hands, while the incomplete superficial palmar arch was found in three hands. The most frequent complete palmar arch was type IB, followed by type IIB, and finally type IA and type IIA. The most common relation was with the Kaplan cardinal line type A to the apex of the arch and with type B to the curvature of the ulnar artery. Conclusions There is a great anatomical variability in the superficial palmar arch. There was a greater frequency of the complete superficial palmar arch, with the ulnar artery being the dominant vascular supply. The Kaplan cardinal line can be used as a safety limit to avoid the superficial palmar arch if it is drawn to intersect the pisiform bone. Clinical Relevance It is important to be aware of the anatomical variants of the superficial palmar arch, as well as of its relationship with the superficial structures of the hand to be able to perform invasive or reconstructive procedures and to preserve the vascularity of the hand.

Virtual reality has been used in orthopedics for several years now, both as a training and assessment tool. The use of extended reality technologies in surgical training and simulation is the most developed and validated of all the current applications. However, formal and massive implementation in continuous orthopedic education has yet to happen. This report aimed to present our experience during the first AO trauma regional courses in Latin America that incorporated the use of immersive virtual reality (IVR) simulation as a hands-on activity as part of the program. IVR was used for the first time as part of a course activity during the advanced principles of fracture treatment course as part of the AO regional courses in Rio de Janeiro, Brazil, in 2022. The activity was implemented for 120 participants in a back-to-back fashion. Each participant used the IVR simulation for the trochanteric nail application and did a traditional hands-on exercise with a synthetic bone model. An appreciation survey was answered by participants. Seventy-four persons answered the survey. About 62% considered that the IVR simulation was like reality, and 76.38% thought that IVR was helpful in the learning process. The majority (91.6%) would like to use IVR for training, and 93% would be willing to use IVR again. This was the first time, IVR simulation was implemented as a massive and structured educational activity during the principles of fracture treatment course. Participant feedback was positive, and most people would use IVIR again. A systematic way of implementing IVR simulation sessions with educational goals needs to be developed for these activities.

Compresión del nervio cubital en codo por condromatosis sinovial primaria Ulnar nerve compression at the elbow by primary synovial chondromatosis

Introduction: Since March 11, 2020, the COVID-19 pandemic was declared by the World Health Organization. This has disrupted face to face educational activities all over the world. During 2021, face-to-face educational events have been slowly reinstated. Objective: The objective of this report is to share our experience during the first face-to-face educational activities after 17 months without face-to-face events from AO Trauma Latin America. Material and methods: Sanitary precautions were followed closely throughout the courses. CO 2 level monitoring helped us improve ventilation and airflow in the different areas of the hotel where the course took place. Three hundred and sixty surveys were sent to the basic principles course participants to inquire for COVID-19 symptoms five days after the courses. Results: We managed to keep the CO 2 levels under 500 ppm for most of the time. Only 41 participants responded. Only one participant from the Chilean courses reported having symptoms and had a positive SARS-CoV-2 PCR test five days after the course. No participants, faculty or staff members from the Mexican courses reported symptoms. Conclusion: Careful planning and scouting of the physical space for incorporating safety measures where the activity will take place should be considered. Independent of vaccination status and pre-course testing, we suggest enforcing the mandatory use of facemasks by everyone indoors, constant hand hygiene, and short intervals of space occupation. These interventions, together with adequate ventilation strategies, and CO 2 monitoring can help decrease the possibility of COVID-19 outbreaks while allowing face-to-face events to take place.