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.

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Many patients who sustain high energy compound fractures of lower extremities are riddled with severe contamination of wound with soft tissue loss. This results in deep infections, non unions and in few cases, amputations. We present a case series of 10 cases with compound fractures of foot with severe degloving injury and wound contamination. Treatment entailed through debridement and was with 5 litres of saline along with betadine. Fractures were fixed with K wires and wound was covered with primary VAC application. Male to female ratio was 8:2. Most of the cases were road traffic accidents. The average number of VACs applied were 2.3. 80% cases underwent split skin graft. We conclude that VAC with K wire fixation is an effective and safe treatment in compound fractures of foot with degloving injuries.

Introduction: Osteoarthritis of the Knee with Tibial stress fracture is not so common entity. It poses additional challenges for doing Total Knee Arthroplasty. We studied the radiological and functional outcome of Single-stage total knee arthroplasty with long stem components for patients with grade 4 of knee osteoarthritis and proximal tibia stress fractures. Materials and Methods: We analysed 15 patients with proximal tibia stress fractures associated with Grade 4 knee osteoarthritis. The mean age was 66 years (range, 52-80) and included seven men and eight women. Diagnosis of stress fractures was seen on x rays and clinical examination. Standing X Ray views were obtained for all patients preoperatively and postoperatively. All patients were treated with TKA with long stem (PCL sacrificing). Union of the fracture site studied using plain anteroposterior (AP) and lateral leg x-rays at regular intervals. Results: The mean follow-up period was 17.2 weeks (range of 12-24) months. All patients experienced significant reduction in pain and improvement in functional status. The range of motion of the knee improved significantly. Flexion of knee improved from mean of 88 degrees (60-110) to 122 degrees (100-140). The fixed flexion deformity also decreased from mean of 10 degrees (5-15) to mean of 1 degree (0-5) The Knee Society score and Knee Society functional score had excellent improvements of approximately 825 and 83% respectively. All proximal tibia stress fractures were united till with an average time of 10 weeks (8-12 weeks). Conclusion: Single-stage Long stem TKR is a good and reliable surgical option for proximal tibial stress fractures with grade 4 OA.