key: cord-0910528-le0edzzr
authors: Schepers, Tim
title: Pandemic Lockdown Does Not Flatten the Curve of Complex Foot Ankle Injuries
date: 2020-06-24
journal: J Foot Ankle Surg
DOI: 10.1053/j.jfas.2020.06.006
sha: 7d8a89239115d90a7179e6885774df045b083de0
doc_id: 910528
cord_uid: le0edzzr

nan

Trauma Unit, Amsterdam UMC location AMC Meibergdreef 9, Amsterdam, The Netherlands.

Corresponding author: Tim Schepers Email: t.schepers@amsterdamumc.nl Few would have expected the massive implications to the world population, economics and health care system following the first COVID-19 case from Wuhan China early December 2019.

The first case in the Netherlands was seen on February 27th 2020. First a part of the Netherlands was on high alert, but on March 23th 2020 the entire country was put in what was called an intelligent lockdown. Compared to other countries this was not a complete lockdown, people were allowed to leave their houses, but several strict rules (stay at home as much as possible, work from home as much as possible, no shaking hands, keep 1.5m distance) were set to flatten the curve and prevent mass spread of the virus, especially to the elderly and frail patients. intra-articular calcaneal fractures (of which 1 was the definitive surgery following the closed reduction of the subtalar dislocation). When taking a closer look at the 11 calcaneal fractures five were work related (fall from ladder or scaffold), two occurred at home, a bilateral fracture was due to a jump from height during a psychosis, and two were sports related accidents. Compared to the same time-period in previous years, the number of calcaneal fractures treated surgically increased (2016: 5, 2017: 8, 2018: 8, 2019: 2), but the distribution of injury mechanism remained the same (about 50% work related). On average 3.1 calcaneal fractures are treated surgically at our hospital per month (1) . All patients were screened prior to their surgery using viral (PCR) testing, and in the acute patients a CT chest was obtained to rule out infection as much as possible to lower the risks for staff and spreading.

Please take note this is not meant as a scientific paper. It is merely an observation from one Level-1 hospital (out of eleven Level-1 trauma-centres in the Netherlands, on a total of 71 hospital organisations with 120 locations serving a population of 17,4 million). It does however show that even in a pandemic (intelligent) lockdown not all non-covid care comes at a full stop nor should it be neglected, due to the risks of increased morbidity and lower patient satisfaction in complex foot ankle injuries if treated too late or inadequately (2) . Of course one should outweigh these risks against the risks related to the virus to care-providers and patients. And finally, we should take good care of ourselves, our loved-once, and our fellow-men (including foot-ankle patients).

Risk factors for surgical site infections with the Sinus Tarsi Approach in displaced intra-articular calcaneal fractures; a prospective cohort study with a minimum of one year follow-up

The timing of ankle fracture surgery and the effect on infectious complications; a case series and systematic review of the literature