Australia has since the start of April had a fantastic community response to the COVID pandemic. But until there is a vaccine, it is expected society & medicine will not return to normal. If society remains quiet for another 4-6 weeks, we won’t just have “flattened the curve” but we could be in a position that the virus is almost eliminated through contact tracing. Previously, the concern was to avoid overwhelming the medical system. Now the idea is to eradicate the virus.
The Next Phase
Once the society lockdown is finished, when our medical supply chain is assured, we will no doubt be doing elective surgery. Patients with severe pain or disability should remind us they need to be done ASAP. It should only take a few weeks once we have the green light for category 2 surgery to clear the backlog.
We have a difficulty that no COVID test can prove you don’t have the virus. At the moment, we can only prove those who have had the virus & are now immune. During the early phases, you may have no symptoms. So we need all of society to be safe with no new virus cases.
BallaratOSM can still provide treatment.
Between telemedicine & internet radiology, we can sort out many patients without face to face meetings. We are sending text messages to individual patients with as clear instructions as possible. Some patients require plasters to be removed or stitches to be removed, but MOST of our patients have dissolving stitches. If you are required to attend – don’t bring books, drinks or handbags into our building. Wash you hands as soon as you arrive.
Telephone calls and video phone calls are the new reality. We will telephone at the appointment time. We will either need credit card details or bulk bill you depending on your circumstances. We can look at XR’s over the internet. If you don’t have a referral, you will need to speak with our registrar first, who will arrange any details before you speak to the specialist orthopaedic surgeon. We cannot provide surgical care for people outside of the Ballarat & Western District region. Many computers have video cameras built in. If we have your email address, we can use “Zoom” to do video consultations over the internet.
What surgery are we doing currently?
• Fractures unable to be managed with closed reduction & casting /bracing / strapping
• Infections not reasonably treated with antibiotics alone
• Tendon ruptures & lacerations not reasonably managed non operatively (finger flexor tendons, pec major, triceps, achilles avulsion from bone)
Urgent (category 1) orthopaedic surgery
• Some emergency surgery is done as planned urgent surgery (see above)
• Malignant & potentially malignant tumours
• Imminent fractures (related to tumours, loose implants, extreme pain with weight bearing)
• Tendon ruptures not reasonably managed non operatively (finger flexor tendons, pec major, triceps, biceps at elbow, achilles avulsion from bone)
• Severe nerve compression where no other treatment available
• Locked knees (osteochondritis dissecans, meniscal tear with or without ACL)
• Locked fingers (as opposed to trigger fingers that sometimes lock)
• Primary or revision joint replacements are rarely indicated for falls or extreme intractable pain causing imminent admission to hospital
Some essential surgery (category 2) is being undertaken for:
• Severe pain preventing sleep, work, or ability to function around the house
• Some high yield operations where limited resources are required
• Day surgery cases are also being limited to 25% capacity currently.
• Since we are working with very restricted capacity, we are avoiding surgery if situation is manageable with tablets, walking aids or splints
Most elective surgery (category 3) has been put on hold for a number of reasons:
• Limited anaesthetic resources.
• Limited Personal Protective Equipment availability.
• Safety of staff and patients. (Prevent Coronavirus spread).
There is still value in having an appointment
Some orthopaedic conditions can be reasonably managed, or temporised with the best non operative treatment. Our orthopaedic surgeons and sports medicine team are expert in this. For patients where surgery is inevitable, we are making arrangements for their surgery and prioritising the patients so we can get you sorted out as soon as the Department of Health eases restrictions.
If you are required by us to attend at BallaratOSM.
Do not come if you are sick, phone instead.
If you have a cough, or sneeze, you will be asked to leave unless you are wearing a mask.
Do not bring extraneous items into the building.
Go directly to washing your hands.
Keep your distance from other people.
Be kind to other people – everyone is stressed.
If you were required to have an XR – DON’T.
Specialist orthopaedic surgeons will work with what they have. If we don’t have everything, we’ll be OK. If we really need it, we’ll arrange it. If we needed you to have an MRI or CT scan, please do so as planned.
Radiology Providers that we can see imaging from.
Ballarat Base Hospital (try to leave this to the virus sufferers)
Bendigo Radiology (including Stawell & Ararat)
Healthcare (eg Wimmera)