Peri-operative SARS-CoV-2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS-CoV-2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre-operative SARS-CoV-2 infection were compared with those without previous SARS-CoV-2 infection. The primary outcome measure was 30-day postoperative mortality. Logistic regression models were used to calculate adjusted 30-day mortality rates stratified by time from diagnosis of SARS-CoV-2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre-operative SARS-CoV-2 diagnosis. Adjusted 30-day mortality in patients without SARS-CoV-2 infection was 1.5% (95%CI 1.4-1.5). In patients with a pre-operative SARS-CoV-2 diagnosis, mortality was increased in patients having surgery within 0-2 weeks, 3-4 weeks and 5-6 weeks of the diagnosis (odds ratio (95%CI) 4.1 (3.3-4.8), 3.9 (2.6-5.1) and 3.6 (2.0-5.2), respectively). Surgery performed ≥ 7 weeks after SARS-CoV-2 diagnosis was associated with a similar mortality risk to baseline (odds ratio (95%CI) 1.5 (0.9-2.1)). After a ≥ 7 week delay in undertaking surgery following SARS-CoV-2 infection, patients with ongoing symptoms had a higher mortality than patients whose symptoms had resolved or who had been asymptomatic (6.0% (95%CI 3.2-8.7) vs. 2.4% (95%CI 1.4-3.4) vs. 1.3% (95%CI 0.6-2.0), respectively). Where possible, surgery should be delayed for at least 7 weeks following SARS-CoV-2 infection. Patients with ongoing symptoms ≥ 7 weeks from diagnosis may benefit from further delay.

SARS-CoV-2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri-operative or prior SARS-CoV-2 were at further increased risk of venous thromboembolism. We conducted a planned sub-study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS-CoV-2 diagnosis was defined as peri-operative (7 days before to 30 days after surgery); recent (1-6 weeks before surgery); previous (≥7 weeks before surgery); or none. Information on prophylaxis regimens or pre-operative anti-coagulation for baseline comorbidities was not available. Postoperative venous thromboembolism rate was 0.5% (666/123,591) in patients without SARS-CoV-2; 2.2% (50/2317) in patients with peri-operative SARS-CoV-2; 1.6% (15/953) in patients with recent SARS-CoV-2; and 1.0% (11/1148) in patients with previous SARS-CoV-2. After adjustment for confounding factors, patients with peri-operative (adjusted odds ratio 1.5 (95%CI 1.1-2.0)) and recent SARS-CoV-2 (1.9 (95%CI 1.2-3.3)) remained at higher risk of venous thromboembolism, with a borderline finding in previous SARS-CoV-2 (1.7 (95%CI 0.9-3.0)). Overall, venous thromboembolism was independently associated with 30-day mortality ). In patients with SARS-CoV-2, mortality without venous thromboembolism was 7.4% (319/4342) and with venous thromboembolism was 40.8% (31/76). Patients undergoing surgery with peri-operative or recent SARS-CoV-2 appear to be at increased risk of postoperative venous thromboembolism compared with patients with no history of SARS-CoV-2 infection. Optimal venous thromboembolism prophylaxis and treatment are unknown in this cohort of patients, and these data should be interpreted accordingly.

Abstract Congenital talipes equinovarus (CTEV) or clubfoot is a congenital deformity that involves an abnormal position of the calcaneonaviculare complex. "Bangla clubfoot tool score system" is an assessment that indicates the effectiveness of CTEV management. The purpose of this study was to evaluate the management of CTEV on children's ability to walk as assessed by the Bangla clubfoot tool score system. A cross sectional study was conducted at the Hospital Dr. Mohammad Hoesin Palembang. There were 24 CTEV patients who received CTEV management before the age of 3 years and were not associated with a neurological disorder. A comparison of the average total Bangla clubfoot score tool system was analyzed by assessing parental satisfaction, walking ability and clinical examination. The majority of CTEV patients were women (58.3%) with and mostly being treated before 1 year old (79.2%). The most types of CTEV were bilateral (70.8%), and most of them performed surgery (66.7%). Assessment with the Bangla clubfoot tool system shows that the level of parental satisfaction is sufficient, gait is good, but physical foot examination is poor (20%). The score is influenced by age at first therapy and compliance using the brace. Parents must continue to support their children to undergo integrated management after therapy to maintain their walking ability.

Abstract: Total elbow arthroplasty (TEA) has proven to be a reliable joint replacement procedure that has a high degree of patient satisfaction. Despite these favorable outcomes, few patientswith disabling elbow degenerative conditions have TEA recommendedto them as an alternative procedure by rheumatologists, physiatrists,or orthopedists. The semi-constrained, hinged (linked) prosthesis is the most commonly used prosthesis.This prosthesis is stable postoperatively. Patients are encouraged to do range of motionexercises and use their elbow for activities of daily living as dictated by their pain leveland status of wound healing. Wound management is critical following TEA. A posterior triceps–sparing approach, which preserves the continuity of the triceps, whenpossible, is typically used. Postoperatively the therapist and patient need to respect the integrity of the triceps and posterior incision when performing both active and passiveelbow flexion exercises and functional activities. The surgeon may choose to limitflexion range of motion based on the intraoperative inspection of the triceps tendon. We have study on 5 cases patients with elbow arthrosis and went TEA for management of elbow pain and joint limitation of movement