Philippine Journal of Surgical Specialties Vol. 75, No. 1, January-June 2020, pp 78

POA COVID-19 Guidelines for Fellows

Author(s): Philippine Orthopaedic Association

The POA remains to be the national organization of board-certified Orthopaedic Surgeons in the country. In this time of COVID 19 pandemic, the POA recognizes the need for its fellows to function beyond the usual scope of orthopaedic practice, remaining first and foremost a responsible and capable practicing physician.

Should the need and situation arise however, that our fellows are called to perform urgent or emergent orthopaedic surgery, the POA remains cognizant of its being a strong affiliate society of the Philippine College of Surgeons. The PCS Guidelines on the conduct of emergent surgeries during these trying times are fully supported and advocated by the POA (See PCS guidelines March 22, 2020). In addition to the guidelines stipulated by the PCS, the POA suggests the following conditions to be considered for emergent orthopedic intervention, granting full availability of resources.

  1. Unstable pelvic fractures with persistent hemodynamic instability
  2. Open type 2 and 3 long bone fractures
  3. Septic joints and open joint injuries
  4. Spine cases needing immediate decompression (neurologic deterioration of sudden onset, cauda equina syndrome) and/or stabilization
  5. Compartment syndrome
  6. Degloving injuries
  7. Diabetic feet with concomitant sepsis
  8. Musculoskeletal tumor bleed and other vascular injuries

Cases which are not life or limb threatening but needing early care to prevent major complications may be classified as urgent in nature and may need to be considered on a case to case basis. Recommendations from POA Subspecialty Societies will be forthcoming.

All cases identified for surgery should follow PCS guidelines for preoperative, intraoperative and postoperative management including equipment preparation, manpower delegation, postoperative transfers and facilitation of early discharge within 48 to 72 hours.

The POA also reiterates its concern for its fellows’ sustained safety, and as such, recommends an institution-based systematic decking of duties, allowing for the longest possible amount of time between duties for those concerned, be they at the ER or in the Operating Theaters.

Key words: Orthopaedic Surgeons