The COVID-19 pandemic has had a major impact in healthcare systems across the world, with many hospitals having to come up with protocols and measures to contain the spread of the virus. This affects various specialties' clinical practices in many ways. Since early 2020 in Singapore, the Department of Otorhinolaryngology at Tan Tock Seng Hospital had to rapidly adapt to this pandemic as we provided services to the main healthcare facility combating the virus in our country. We had to design new workflows and also remain flexible in view of the ever-changing situation. There are 6 important domains for an otolaryngology department or any clinical department in general to consider when making adjustments to their practices in an outbreak: (1) clinical work, (2) education, (3) research, (4) safety of patients and staff, (5) morale of medical staff and (6) pandemic frontline work. We hope that the sharing of our experiences and the lessons learnt will be useful for both our local and international colleagues.
Ambulatory Care ; Biomedical Research ; COVID-19/prevention & control* ; Delivery of Health Care/methods* ; Education, Medical ; Elective Surgical Procedures ; Health Workforce ; Humans ; Morale ; Otolaryngology/methods* ; Otorhinolaryngologic Surgical Procedures ; Personal Protective Equipment ; Personnel Staffing and Scheduling ; SARS-CoV-2 ; Singapore/epidemiology* ; Workflow

COVID-19/transmission* ; Communicable Disease Control/organization & administration* ; Education, Distance/organization & administration* ; Education, Medical/organization & administration* ; Humans ; Otolaryngology/organization & administration* ; Singapore/epidemiology* ; Telemedicine/organization & administration*

Aged ; Humans ; Ischemic Attack, Transient ; etiology ; Male ; Polycythemia Vera ; complications ; diagnosis

Background: Intramedullary devices for the fixation of intertrochanteric fractures are increasing in usage and popularity. This reflects either a shift in adoption of new technology or intertrochanteric fractures becoming more complex or unstable. This trend was observed in our institution, hence we set out to investigate if this was concordant with an associated change in the demographics of the patients or in the morphology of the intertrochanteric fracture pattern over a 10-year period. Methods: This is a retrospective cross-sectional comparison undertaken for the first 100 consecutive elderly patients with intertrochanteric fractures admitted to our tertiary institution over 3 yearly intervals, in each of the years 2004, 2007, 2010, and 2013.Fractures were radiologically classified via the Evans and AO classifications. Patient demographics such as age, ethnicity, and comorbidities and surgical data including time, type of fixation, time to surgery, and length of stay were collected via case note reviews to identify possible trends. Results: The overall mean age was 80.5 years, with no statistically significant trend among age, sex, ethnicity, and comorbidities over the 10-year period. The main finding was a rise in the proportion of unstable intertrochanteric fractures. The proportion of such fractures was 30% in 2004, 42% in 2007, 47% in 2010, and 62% in 2013 (p < 0.001). Patients admitted for intertrochanteric fractures also experienced a shorter hospital length of stay and an increasing trend towards early fracture fixation (p < 0.001), with a greater usage of intramedullary nails in the treatment of such fractures (p < 0.001). Conclusions Intertrochanteric fractures in elderly patients have evolved into more complex fractures over the past ten years, despite there being no change in the age of the patients over the same duration. This increasing proportion of unstable intertrochanteric fractures has brought about a greater tendency to fix these fractures with intramedullary implants.

Anesthesia, General ; Coronavirus Infections ; prevention & control ; transmission ; Humans ; Infectious Disease Transmission, Patient-to-Professional ; prevention & control ; Occupational Exposure ; prevention & control ; Operating Rooms ; Otorhinolaryngologic Surgical Procedures ; Pandemics ; prevention & control ; Personal Protective Equipment ; classification ; Pneumonia, Viral ; prevention & control ; transmission ; Practice Guidelines as Topic

INTRODUCTION: Isolated oval window atresia (OWA) is a rare cause of congenital conductive middle ear deafness and may be overlooked owing to the normal appearance of the external ear. This anomaly has been previously described, although the published numbers with both imaging and surgical findings are few. Our aim is to correlate the imaging features of OWA with intraoperative findings. MATERIALS AND METHODS: This is a single-centre retrospective evaluation of patients who were diagnosed with OWA and who received surgery from January 1999 to July 2006. No new case was diagnosed after 2006 to the time of preparation of this manuscript. High resolution computed tomography (HRCT) imaging of the temporal bones of the patients were retrospectively evaluated by 2 head and neck radiologists. Images were evaluated for the absence of the oval window, ossicular chain abnormalities, position of the facial nerve canal, and other malformations. Imaging findings were then correlated with surgical findings. RESULTS: A total of 9 ears in 7 patients (two of whom with bilateral lesions) had surgery for OWA. All patients had concomitant findings of absent stapes footplate with normal, deformed or absent stapes superstructure and an inferiorly displaced facial nerve canal. HRCT was sensitive in identifying OWA and associated ossicular chain and facial nerve abnormalities, which were documented surgically. CONCLUSION OWA is a rare entity that can be diagnosed with certainty on HRCT, best visualised on coronal plane. Imaging findings of associated middle ear abnormalities, position of the facial nerve canal, which is invariably mal-positioned, and associated deformity of the incus are important for presurgical planning and consent.

BACKGROUND: Periprosthetic fractures around a total knee replacement (TKR) can be complex and difficult to manage, requiring the surgical expertise of the trauma and arthroplasty surgeon. There are a number of treatment modalities available, each with their own merits and limitations. As data on tumor prosthesis revision in periprosthetic fractures is sparse, this study aims to evaluate the results of revision using a tumor prosthesis and compare them with those of fixation using a locking plate in periprosthetic fractures after TKR. METHODS: This is a retrospective study of 15 patients who underwent either tumor prosthesis revision (n = 7) or locking plate fixation (n = 8) for supracondylar femoral periprosthetic fractures in our hospital from 2009 and 2014. The mean follow-up time for these patients was 44 months. This study's main outcome measures were pain relief, return to premorbid ambulatory function, and complications. RESULTS: The revision and fixation groups saw five versus three patients achieve pain relief (71.4% vs. 37.5%, p = 0.315), and two versus four patients return to their premorbid ambulatory function (28.6% vs. 50%, p = 0.608) at the follow-up, respectively. The mean time to weight-bearing in the revision group and fixation group was 2.9 days and 18.9 weeks, respectively (p = 0.001). There were eight complications seen in the revision group with none requiring reoperation; there were five complications seen in the fixation group, and two required reoperation. CONCLUSIONS: The results of revision TKR using a tumor prosthesis were comparable to those of fixation using a locking plate in periprosthetic fractures after TKR. Tumor prosthesis revision may be considered as a viable alternative to locking plate fixation when indicated.
Arthroplasty ; Arthroplasty, Replacement, Knee ; Follow-Up Studies ; Humans ; Outcome Assessment (Health Care) ; Periprosthetic Fractures* ; Prostheses and Implants* ; Reoperation ; Retrospective Studies ; Weight-Bearing

INTRODUCTIONThe estimated incidence of hip fractures worldwide was 1.26 million in 1990 and is expected to double to 2.6 million by 2025. The cost of care for hip fracture patients is a significant economic burden. This study aimed to look at the inpatient cost of hip fractures among elderly patients placed under a mature orthogeriatric co-managed system.

METHODSThis study was a retrospective analysis of 244 patients who were admitted to the Department of Orthopaedics of Tan Tock Seng Hospital, Singapore, in 2011 for hip fractures under a mature orthogeriatric hip fracture care path. Information regarding costs, surgical procedures performed and patient demographics was collected.

RESULTSThe mean cost of hospitalisation was SGD 13,313.81. The mean cost was significantly higher for the patients who were managed surgically than for the patients who were managed non-surgically (SGD 14,815.70 vs. SGD 9,011.38; p < 0.01). Regardless of whether surgery was performed, the presence of complications resulted in a higher average cost (SGD 2,689.99 more than if there were no complications; p = 0.011). Every additional day from admission to time of surgery resulted in an increased cost of SGD 575.89, and the difference between the average cost of surgery within 48 hours and that of surgery > 48 hours was SGD 2,716.63.

CONCLUSIONReducing the time to surgery and preventing pre- and postoperative complications can help reduce overall costs. A standardised care path that empowers allied health professionals can help to reduce perioperative complications, and a combined orthogeriatric care service can facilitate prompt surgical treatment.

Aged ; Aged, 80 and over ; Female ; Femoral Neck Fractures ; economics ; surgery ; Health Care Costs ; Hip Fractures ; economics ; surgery ; Hospitalization ; Humans ; Inpatients ; Length of Stay ; Male ; Middle Aged ; Orthopedic Procedures ; economics ; Patient Admission ; Retrospective Studies ; Singapore ; Surgical Procedures, Operative ; economics

PURPOSE: Patients with chronic kidney disease (CKD) have a higher risk of complications when undergoing hip hemiarthroplasty. The primary aim is to test the null hypothesis that there is no difference between cemented and uncemented stem loosening rates in patients with CKD who receive a hip hemiarthroplasty for femoral neck fractures. The secondary aim is to determine the effect of increasing severity of renal disease on the rate of stem loosening in this CKD patient subset. MATERIALS AND METHODS: A retrospective study of all patients with CKD who underwent a hip hemiarthroplasty for a traumatic femoral-neck fracture between 2003 and 2013 was performed. Patients with a minimum of two-year follow-up were included; those with pathological fractures or loosening due to infection were excluded. The outcome measure was radiographic aseptic loosening of the stem, defined as progressive radiolucency of more than 2 mm, progressive subsidence or migration of the implant. RESULTS: One-hundred and nineteen cases were included in this study. Loosening occurred in 11 cases (9.24%). A comparison between cemented and uncemented groups revealed no difference in the rate of loosening (P=0.079). In all cases, worsening renal function did not increase the rate of loosening (P=0.311). The rate of loosening did not increase with worsening renal function in either the cemented (P=0.678) or uncemented groups (P=0.307). CONCLUSION: There is no difference in the rate of loosening between cemented and uncemented hemiarthroplasty for femoral neck fractures in the elderly with CKD. The rate of loosening did not increase with worsening renal function. All patients with renal impairment, not just those with end-stage renal failure, warrant close follow-up as early loosening can occur throughout the entire spectrum of renal disease.
Aged ; Femoral Neck Fractures ; Follow-Up Studies ; Fractures, Spontaneous ; Hemiarthroplasty ; Hip Prosthesis ; Hip ; Humans ; Kidney Failure, Chronic ; Outcome Assessment (Health Care) ; Renal Insufficiency ; Renal Insufficiency, Chronic ; Retrospective Studies

There is a paucity of available research on knowledge of orthopaedic implant costs and healthcare schemes among orthopaedic residents. With the rising healthcare costs in Singapore, it is imperative for residents, who are the future surgeons, to understand these issues in order to provide proper counselling and cost-effective management. This study aimed to quantify how accurately they understood these issues and determine if senior residents had better knowledge given their increased experience. An online survey was administered to all orthopaedic residents within a residency programme. There was poor knowledge of implant costs and healthcare schemes among residents. Junior residents fared better at healthcare schemes, while senior residents fared better at estimation of implant costs. Education on these issues should be incorporated into the residency programme to bring about more holistic and cost-conscious clinicians.
Attitude of Health Personnel ; Clinical Competence ; Cross-Sectional Studies ; Education, Medical, Graduate ; Health Care Costs ; Health Knowledge, Attitudes, Practice ; Humans ; Internship and Residency ; Orthopedics ; economics ; education ; Physicians ; Prostheses and Implants ; economics ; Singapore ; Surveys and Questionnaires ; Workload