Background:Coronavirus 2019 (COVID-19) has had a great effect on the health care landscape, including altering the availability and methods of orthopaedic care. There is little information regarding patients' perceptions of orthopaedic care during the pandemic. This study was designed to assess patient concerns surrounding orthopaedic care and determine what areas can be addressed to optimize orthopaedic care during this pandemic. Methods:In the spring of 2020, during this study that was exempt from institutional review board (IRB) approval, a survey designed to evaluate the attitudes and beliefs from healthcare consumers about receiving care during the COVID-19 pandemic was sent to a group of panelists via email. Results:Three hundred sixty-six (31%) out of 1,200 individuals completed the survey. The majority of participants expressed they would feel comfortable receiving care in orthopaedic clinics (48% immediately, 36% in 1 to 3 mo) in the immediate or near future. Participants reported they were more comfortable seeking orthopaedic care at an orthopedic urgent care facility (8% not comfortable) versus an emergency room (41% not comfortable). When thinking about receiving care at orthopaedic clinics, participants were most concerned about the risks of getting sick from other patients (18% extremely, 26% very). Seventeen percent of respondents reported that despite having orthopaedic concerns, they delayed seeking care due to COVID-19. One-third of respondents expressed a desire to know what precautions were in place to ensure safety. Conclusions:Patients remained interested in receiving orthopaedic care in the midst of a pandemic. As a result, physicians need to ensure that they effectively communicate what safety precautions are in place and what additional infection prevention measures are available.

Bleeding after total knee arthroplasty increases the risk of pain, delayed rehabilitation, blood transfusion, and transfusion-associated complications. The authors compared pre- and postoperative decreases in hemoglobin as a surrogate for blood loss in consecutive patients treated at a single institution by the same surgeon (J.L.C.) using conventional hemostatic methods (electrocautery, suturing, or manual compression) or a gelatin and thrombin-based hemostatic matrix during total knee arthroplasty. Data were collected retrospectively by chart review. The population comprised 165 controls and 184 patients treated with hemostatic matrix. Median age was 66 years (range, 28–89 years); 66% were women. The arithmetic mean±SD for the maximal postoperative decrease in hemoglobin was 3.18±0.94 g/dL for controls and 2.19±0.83 g/dL for the hemostatic matrix group. Least squares means estimates of the group difference (controls–hemostatic matrix) in the maximal decrease in hemoglobin was 0.96 g/dL (95% confidence interval, 0.77–1.14 mg/dL; P <.0001). Statistically significant covariate effects were observed for preoperative hemoglobin level ( P <.0001) and body mass index ( P =.0029). Transfusions were infrequent in both groups. The frequency of acceptable range of motion was high (control, 88%; hemostatic matrix, 84%). In both groups, overall mean tourniquet time was approximately 1 hour, and the most common length of stay was 3 to 5 days. No serious complications related to the hemostatic agent were observed. These data demonstrate that the use of a flowable hemostatic matrix results in less reduction in hemoglobin than the use of conventional hemostatic methods in patient undergoing total knee arthroplasty.

Objective: Examine factors associated with fixation failure in patients treated with superior intramedullary ramus screws. Design: Retrospective. Setting: Single, Level 1 trauma center. Patients: Unstable pelvic ring fractures amenable fixation that included superior intramedullary ramus screws. Intervention: Percutaneously inserted intramedullary superior ramus screw fixation of superior pubic ramus (SPR) fractures. Main Outcome Measurements: Loss of reduction (LOR) of the SPR fracture defined as >2 mm displacement on pelvic radiographs at any time point in follow-up. Results: Two hundred eighty-five fractures in 211 patients (age 44, 95% confidence interval 40.8%–46.4%, 59.3% women, 55.1% retrograde screws) were included in the analysis. 14 (4.9%) of fractures had LOR. Patients were significantly more likely to have LOR as age increased (P = 0.01), body mass index (BMI) increased (P = 0.01), and if they were women (P < 0.01). There was a significantly decreased LOR (P < 0.01) as fractures moved further from the pubis symphysis. Retrograde screws were significantly (P < 0.01) more likely to have LOR. In SPR fractures treated with retrograde screws, failure was significantly associated with increasing BMI (P = 0.02), the presence of an inferior ramus fracture (P = 0.02), and trended toward significance with increasing age (P = 0.06), and decreased distance from the symphysis (P = 0.07). Conclusions: Superior ramus screws are associated with a low failure rate (4.9%), which is lower than previously reported. Retrograde screw insertion, distance from the symphysis, increasing age, increasing BMI, decreased distance from the symphysis, and ipsilateral inferior ramus fractures were predictors of failure. In these patients, alternative modalities should be considered, although low rates of failure can still be expected. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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Introduction: Cephalomedullary nail (CMN) length for intertrochanteric femur fractures without subtrochanteric extension has been an ongoing debate. The authors hypothesize that increasing nail length would result in increasing surgical time, greater incidence of acute kidney injury (AKI), postoperative anemia, and blood loss requiring transfusion due to increased intramedullary reaming and pressurization of the canal with nail insertion.Methods: A retrospective chart review of patients aged 65 years or older who underwent CMN for low-energy intertrochanteric femur fractures from 2010 to 2018 was undertaken. Patient demographic data, comorbidities, case duration, postoperative hospital length of stay (LOS), and laboratory data, including serum creatinine, hemoglobin, and hematocrit, were collected for analysis. The following outcome measures were compared: postoperative pneumonia, cardiac complications, sepsis, reintubation/intensive care unit stay, pulmonary embolism, stroke, postoperative AKI, 30-day hospital readmission, 30-day return to operating room, 30-day mortality, 1-year mortality, postoperative anemia (hemoglobin ,7 g/dL), and blood transfusion.Results: A total of 247 patients were analyzed (short = 48, intermediate = 39, and long = 160). No notable difference was observed in postoperative pneumonia, cardiac complications, sepsis, reintubation/intensive care unit stay, pulmonary embolism, stroke, mean total hospital LOS, mean postoperative hospital LOS, rate of postoperative AKI, 30-day readmission, 30-day return to operating room, 30-day mortality, or 1-year mortality. Patients receiving long nails had significantly higher rates of postoperative anemia (P = 0.0491), blood transfusion (P = 0.0126), and mean procedure length (P = 0.0044) compared with the two other groups.Discussion: Patients receiving long nails had markedly higher rates of postoperative anemia and blood loss requiring blood transfusion with