Is COVID-19 affecting the incidence of hip fractures?The Covid-19 pandemic is caused by the Coronavirus-2 of Severe Acute Respiratory Syndrome (SARS-CoV-2). It was first described in December 2019 in the city of Wuhan, capital of the central chinese province of Hubei, when a group of people with unknown pneumonia were reported [1] . In Europe, the first case of Covid-19 was described in France on January 25th 2020. On February 21, a large outbreak was reported in Italy, mainly in the north, near Milan [2] . The cases grew rapidly and the World Health Organization (WHO) recognized it as a global pandemic on March 11th, 2020 [3] .To prevent the spread of the virus, many governments of different nations have imposed travel restrictions, quarantines, confinements, cancellation of events and closure of non-essential establishments [4] . In Spain the government decreed the state of alarm on March 14th, which limited the free movement of citizens with little exceptions (such as basic services). In practice, this involved a period of confinement that lasted for weeks [5] .In our centre, the effect of one month of confinement was analyzed on the incidence of hip fractures in a prospective cohort of patients. The first result to highlight is the important decrease in the total number of fractures diagnosed during the confinement (32) compared to the monthly average (48,25). This is even more surprising when compared to the same period of time of the previous year (63), finding a decrease in almost half of the hip fractures diagnosed (49,2%).The 93,75% of these patients patients underwent surgery in less that 48h which is the ideal aim nowadays, moreover 73,66% of them were operated in less than 24 hours which is the next objective in our specialty [6] . The mean hospital stay was 4,98 days while in 2019 the mean hospital stay was 6,47 days. This 1.5 days of difference can be explained by the willingness of both, patients and families, to return to their homes as soon as possible, since Hospitals are a risk place for Covid-19 infection.A significant number of patients live alone or accompanied by another elderly person in their homes, which can increase the risk of falls, as these patients carry out more activities at home [7] . Among our patients 59,37% lived according to these conditions. Social alarm and fear of the coronavirus created during the state of alarm has been able to influence patients and relatives when going to the Hospital after a fall with suspected hip fracture. We surpris-ingly found that 18,75% of patients with a hip fracture (all living with a relative) were afraid of the virus and delayed a mean of 2.5 days their visit to the Hospital due to fear.

As a conclusion, obesity (BMI ≥30 kg/m²) does not have any clinical relationship with the appearance of a periprosthetic fracture around the knee (p < 0.05).

Background There is still little information about the long-term results of clinical and radiological evolution in patients older than 65 years with complex proximal humerus fractures (CPHF) treated acutely with reverse shoulder arthroplasty (RSA). The aim of this paper was to evaluate function and results 7 years after surgery. Material and methods A prospective cross-sectional cohort study was designed for this purpose. Patients who underwent RSA surgery during 2012 because of a CPHF were included. The surgical approach was randomized (deltopectoral vs anterosuperior). Functional activity, evolution of tuberosities and evidence of scapular notching 7 years after surgery were analyzed. Results After evaluating 32 patients, the Constant score improved from 64.83 in the first year to 69.54 at 7 years postoperative. Results were independent of the approach used. Functional outcomes were poorer in patients with scapular notching and when tuberosities were resorbed or displaced. Conclusions At 7 years, function in patients undergoing RSA after CPHF demonstrated improvement in all patients except those who developed scapular notching or when tuberosities did not consolidate in an anatomical position. These results are completely independent of the approach used. Level of evidence III Controlled cohort study.

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Background: Glenohumeral arthropathy after surgery for traumatic shoulder instability is a condition whose etiology and long-term course are still unknown. Purpose: To evaluate the risk factors for the onset of arthropathy and to assess the relationship between the degree of arthropathy and final outcomes. Study Design: Case series; Level of evidence, 4. Methods: We included patients who underwent surgery for a shoulder instability at a single institution between 2000 and 2004. The following variables were studied for relationship with functional outcomes: sex, age, body mass index, smoking at the time of surgery, number of episodes of shoulder dislocation, and time from first dislocation to surgery. The number of anchors used and their position were also evaluated. Functional outcomes were assessed using the Constant-Murley, Western Ontario Shoulder Instability Index, and Rowe scores, and results were compared with the onset of arthropathy according to Buscayret classification. Spearman and Pearson correlations were performed for the association between glenohumeral arthritis (Buscayret grade) and the study variables, the Mann-Whitney U test and Student t test were used to compare outcome scores with the study variables, and the Kruskal-Wallis test was used to compare Buscayret grade and outcome scores. Results: A total of 26 shoulders in 25 patients were analyzed, finding a high rate (54%) of arthropathy at a minimum follow-up of 16 years. Patients with Buscayret grade 4 had the worst functional results ( P = .007). However, 80% of patients with Buscayret grade ≤3 had excellent Constant-Murley scores. A significant relationship was found between degree of arthropathy and patients who were smokers before surgery ( P < .01). No relationship was found between the onset of arthropathy and the other variables analyzed. Conclusion: Postinstability glenohumeral arthropathy was not correlated with functional outcomes except in those patients with advanced arthroplasty (Buscayret grade 4). A direct relationship was found between smoking before surgery and the onset of glenohumeral arthropathy.