It is our responsibility to be aware of the current knowledge on COVID-19 such as the pathogenesis, clinical features, and the precautions that we have to follow while handling orthopedic patients. A detailed look into the current protocol and suggestions of orthopedic practices in the COVID-19 outbreak has done here. A review of articles indexed for MEDLINE on PubMed and Scopus using the keywords COVID-19 and orthopedics and as a Boolean search was used. The review included evidence from 44 articles from orthopedic literature. There are risks associated with orthopedic practices in the COVID-19 pandemic, and many standard protocols are available to confront the situation. This article highlights useful recommendations and directions for orthopedic practices in the COVID-19 outbreak.

This article highlights the influence of coronavirus pandemic in patient care from an Orthopedic surgeon's perspective and enumerates the modifications in routine practice while providing quality service to the society. The authors have reviewed the recently available articles regarding the changes in orthopedic practice with respect to the coronavirus disease pandemic. Prioritizing surgical treatment of obligatory fractures and conservative management of non-obligatory fracture will be the cornerstone of management strategy in patient care during these troubled times. Formalizing evidence-based protocols for various subsets of orthopedics not only reduces the event-response time lag but also helps in accurate implementation of services for the best patient outcome.

A 42 year old lady presented with acute onset “recurrent” cauda equina syndrome (CES) as a result of repeated disc prolapse at L4-L5 level on the left side, which was operated 10 years earlier. The patient had a previous successful surgery for cauda equina syndrome at the same level(left sided prolapse) and a symptom free period of 10 years. She presented with acute onset left lower limb radicular pain, inability to walk and void urine. Revision surgery by Posterior decompression and Discectomy L4 - L5 with Instrumented Posterolateral Fusion (PLF) from L3 - L5 were performed. There was intra operative dural tear which was primarily repaired. She regained bowel and bladder control post operatively in 10 days time. She became completely ambulant without any residual deficit. Recurrent cauda equina syndrome due to disc prolapse at the previously prolapsed site after a surgical intervention is not reported in the literature, to the best of our knowledge.

Flexor tenosynovitis is a common hand infection and if not addressed early with effective treatment can result in permanent disability. A horseshoe abscess is a well-known aggressive variant of flexor tendon sheath infection occurring due to the spread of infection through the interconnections between the deep spaces of the hand. Early diagnosis and prompt and effective treatment are crucial in avoiding late complications. We report a case of horseshoe swelling of the hand following a penetrating injury treated successfully by surgical debridement and closed catheter irrigation.

Patella tendon avulsion injury following total knee arthroplasty (TKA) is one of the rarest complications to occur. A breach in the extensor mechanism severely affects the knee function. A spectrum of treatment options with unpredictable outcomes is enumerated in the literature. We present a case of patellar tendon avulsion injury following TKA in a 74-year-old diabetic woman managed by percutaneous extraarticular reconstruction using artificial ligament.

Nonossifying fibroma (NOF) is a nonneoplastic lesion of the long bones which are rarely seen after skeletal maturity. The disorder is most often asymptomatic, discovered incidentally on plain radiographs and spontaneous regression over the years is typical. Nevertheless, larger lesions are at an increased risk of pathological fracture and together with atypical radiographic features can cause concern leading to consultations in orthopedic oncology clinics. A correct diagnosis can be established after a careful study of the patient's history and clinical status together with different imaging modalities and histologic characterization of the lesion. Surgical treatment may be required to forestall fractures in symptomatic lesions. Recurrence is rare after surgical intervention. Here, we report an interesting case of a pathological fracture through a symptomatic NOF with a 1-year follow-up, after surgical intervention.

Superior dislocation of the patella is an extremely rare clinical entity, which is frequently misdiagnosed as acute patellar tendon rupture. Locked knee in extension is the classical presentation, and plain radiographs are most often diagnostic. Closed reduction can be accomplished in majority of cases, and we report superior patellar dislocation in an elderly female following trivial trauma, successfully managed by closed reduction under local anesthesia.