Introduction: There are suggestions that elective surgery performed during the incubation period of COVID-19 infection may cause an immediate impairment of cell-mediated immunity, leading to high morbidity and mortality. However is contrasting data about the associated mortality. Since the outbreak, our unit has maintained a prospective database recording Trauma and Orthopaedic surgical activity. Our aim was to share our experience of the first 3 months with prospective data on outcome of essential surgery during the covid-19 peak. Our focus in this report was on the mortality rate as services begin to open. Methods: We prospectively collected data during the peak of the pandemic in the UK, for fracture neck of femur patients (NOF) the most commonly performed surgical procedure and the most vulnerable during this period. We compared this Covid-19 cohort of NOFs against a cohort of NOF's during the same time in 2019 and another cohort of NOF's in 2020 outside the lockdown period to compare mortality rates and give a broader perspective. Results: During the period March 1, 2020 to May 31, 2020, total of 206 patients were operated. Ninetyfour fracture NOF and another one hundred twelve essential surgical procedures were performed. In the NOF cohort, there were nine patients that died. Three of them were covid-19 positive, one was not tested and the rest five were covid-19 negative. There was no mortality reported in the non NOF group. Conclusion: In our unit, during the lock down period, mortality rate in patients undergoing fracture NOF was not significantly different from a similar cohort earlier in the year and similar period last year. We have not observed any mortality, to date in the Non NOF procedures carried out.

To support the global restart of elective surgery, data from an international prospective cohort study of 8492 patients (69 countries) was analysed using artificial intelligence (machine learning techniques) to develop a predictive score for mortality in surgical patients with SARS-CoV-2. We found that patient rather than operation factors were the best predictors and used these to create the COVIDsurg Mortality Score (https://covidsurgrisk.app). Our data demonstrates that it is safe to restart a wide range of surgical services for selected patients.

Bone marrow edema is a self-limiting, under-recognized condition. It mainly involves the lower limbs. It is characterized by pain and inability to bear weight. Diagnosis is most often based on imaging and by excluding other causes. Its exact pathogenesis is still debated and various theories are postulated. Treatment ranges from anti-inflammatories to restricted weight bearing. This overview has tried to revisit this rare and perhaps forgotten clinical-radiological condition.

Table 1 Characteristics and laboratory finding of the nine patients that had mortality during the peak of the pandemic Sr. No Age Sex ASA Surgical Procedure COVID-19 Test Status Time to surgery (hours) Time to death (days) Comorbidities Complications Preop CRP Postop CRP Pre-op Lymphocytes count Post-op Lymphocytes count Preop WBC Postop WBC