COVID-19 Effect on Foot & Ankle Surgery in Shiraz, South of Iran.

The first COVID-19 positive patient in Iran was diagnosed in Qom on 19th day of February 2020. Four days later, Shiraz University of Medical Sciences shut down every outpatient clinic and elective surgeries in all its subcategories. At the beginning of the first wave of COVID-19 outbreak, Chamran hospital, the main orthopedic center of Shiraz, used as the second focus point for treating COVID-19 positive patients. Therefore, we had to transfer orthopedic trauma patients to the other clinic, Emtiaz Hospital. Due to the cancellation of all elective surgeries, we had to operate only orthopedic trauma cases.

The first wave of the outbreak in Iran coincided with Nowruz 1399 holidays, a celebration that marks the beginning of the New Year in Iran's official calendar, starting on March 21. Every year, the incidence of traffic accidents victims is abundant on this 2-week holiday, as people usually travel with their own cars. From Sunday February 23, 2020 till Tuesday May 5, 2020, there were no significant changes in foot and ankle trauma cases operated by the senior author in comparison to the last year, as shown in Table . We treated more complex fracture of the tibia plafond, talus, and calcaneus in the first wave of COVID-19 outbreak. We believe that the main reasons were (1) our hospital was the tertiary referral trauma center (2) the senior author was the single orthopedic foot and ankle surgeon in south of Iran. Moreover, most of the cases had been transferred from the adjacent provinces and surrounding cities.

Table

The number of patients operated by the senior author in the first wave of COVID-19 outbreak in Shiraz University of Medical Sciences affiliated hospitals

	Tibial Plafond Fractures	Ankle Fractures	Talus Fractures	Calcaneus Fractures	Midfoot Injuries	Total
This year (n)	6	11	3	22	5	47
Last year (n)	1	16	2	14	12	45