Aim

The coronavirus disease 2019 (COVID-19) pandemic presents significant challenges to healthcare systems globally. Orthopaedic surgeons are at risk of contracting COVID-19 due to their close contact with patients in both outpatient and theatre environments. The aim of this review was to perform a literature review, including articles of other coronaviruses, to formulate guidelines for orthopaedic healthcare staff.

To analyse the causes and factors associated with mortality in patients admitted to ASCI unit in a low- or middle-income country. The study was performed at a Tertiary Hospital at Groote Schuur Hospital, Cape Town South Africa. Data between 1996 –2022 were retrospectively collected from hospital records of patients admitted to the ASCI Unit. There was approximately 3223 admissions for the study period. 682 patients were confirmed dead 87% were male and 64% were unemployed. The mean age was 46 years (ranging from 14 – 87 years). A 1/3 of injuries were caused by a MVA, a ¼ by a fall (low energy and from a height), and 1/5 by a gunshot wound. Average length of stay was 47 days (SD = 52 days), ranging from as short as 1 day to 512 days for one patient. Majority (65%) were admitted for more than a week but less than 2 months 32% were ventilated, and 17% with a CPAP facemask. 10% of patients had a pre-existing ulcer prior to admission. 65% of patients had surgery via the posterior approach, 33% via the anterior approach. On average patients died within 5 years of being admitted to hospital, ranging from dying in the same year as the injury to 20 years later. 73% of the deaths were classified as natural deaths and 20% as unnatural. There is a high mortality in patients with acute spinal cord injury, causes are multifactorial, and in depth critical analyses is required to improve clinical outcomes and rationalise resource allocation

Introduction. Surgical spacesuits are in widespread use. Only one previous study (JBJS 1998) has assessed the quality of the environment within the space suit. They demonstrated that surgical spacesuits could allow re-breathing of carbon dioxide (CO. 2. ). However, they had no control group and performed a vigorous exercise protocol which may have been an unfair test. The design of helmet systems has also evolved in the last decade. We have conducted the first investigation into CO. 2. levels inside the modern space suit. There is a Workplace Exposure Limit for inspired CO. 2. as determined by the Health and Safety Executive (UK), which is 0.506kPa. We wondered whether re-breathing of CO. 2. in space suits would lead to inspired CO. 2. which breaches this level. Methods. We used an anaesthetic room gas analyzer via nasal cannulae to measure inspired (ICO. 2. ) levels in 12 healthy volunteers. Readings were taken while wearing a surgical space suit with the fan on high and low settings. These were compared with a normal surgical facemask. Readings were repeated on mild exertion to simulate the effort of performing arthroplasty surgery. Results. [Frequency of ICO2 >0.5kPa (12 subjects)]. Discussion. Despite the design modifications, modern space suits allow re-breathing of CO. 2. This is more marked with exertion and with low fan settings where ICO. 2. can exceed workplace limits. This may account for symptoms of headache and drowsiness reported after a prolonged period in the suit during arthroplasty surgery. We recommend the use of high fan settings at all times