Fracture Care in the Time of COVID19

This document was based off the fracture guidelines published by our brothers and sisters across the pond at BSCOS as part of their COVID19 resources (https://bscos.org.uk/covid19/resources.php). We have adapted and revised it to be more in line with our practice. The goal is to minimize unnecessary clinic visits for our fracture patients while minimizing malunions. We are also developing patient instructions for our families for various fractures during this time.

Several caveats:
  1. These are only guidelines, NOT rules. Safety of child and minimizing potential complications come first. Clinical judgement is paramount - not all families may be able to safely take their own cast off at home. 
  2. These are only to be used during this COVID-19 period.
BSCOS also has a great youtube video that we will be sharing with parents about removing soft cast at home. https://www.youtube.com/watch?v=epkJ5r1OzvI&feature=youtu.be

Fracture COVID GUIDELINES for CMC UTSW:
https://www.dropbox.com/s/rnseg7ktxwq8swk/Fracture%20COVID%20GUIDELINES%20for%20CMC%20UTSW%20Final.pdf?dl=0


 

 
Comments
John Cashman
Here in Sheffield in the UK we try and see affected babies with their parents soon after birth and explain that whilst stretching alone, without casting, is not a proven treatment, it may have some merit. We run through a powerpoint presentation explaining the principles with them and demonstrate on the baby and then have a video link with them once per week to see how they are going and make sure they are doing it correctly. We also have made a couple of videos - (URL above ) on the hospital website to try and assist. So far it has seemed to help both the babies' feet and the parents to have a focus of something to be doing. Whether it will have a long term benefit remains to be seen. Happy to email you the powerpoint if helpful. Best Wishes, John Cashman. - Consultant Paediatric Orthopaedic Surgeon, UK
4/10/2020 2:31:21 PM
Alison Schiffern
I appreciate the link to the UK recommendations for management of clubfoot. For now, we are completing casting/TAL for patients mid-treatment and have suspended starting new patients with Ponseti casting. We are trying to do surveillance exams by virtual care. I am curious what other organizations are doing in regards to their infantile clubfoot population, and any recommendations on how to alleviate anxiety of families having their child's care delayed for an indeterminate period of time. Thanks!
4/4/2020 1:14:18 PM