Impact of COVID-19 Pandemic on Treatment and Outcome of Fragility Hip Fractures In Non-COVID Patients: Comparison Between the Lockdown Period, a Historical Series and the “Pandemic Normality” in a Single Institution

Abstract

Introduction The COVID-19 pandemic has affected and is still deeply affecting all aspects of public life. World governments have been forced to enact restrictive measures to stem the contagion which have led to a decrease in the movement of people within national territory and to a redirection of health care resources with a suspension of non-urgent procedures. In Italy, a lockdown was imposed from March 9th to May 3rd, 2020. As a result, a significant reduction in the overall operative volume of orthopedic trauma was expected, but it was not possible to predict a similar trend regarding fragility fractures of the proximal femur in the elderly. Methods The aim of this paper was to examine the impact of COVID-19 on the operating volume for trauma surgeries and to determine how the pandemic affected the management of fragility hip fractures (FHFs) in non-COVID patients at a single Institution. Results The first result was a statistically significant reduction in the overall operative volume of orthopedic trauma during the period of the first lockdown and an increase in the mean age of patients undergoing surgery, as expected. As regard to the second aim, the incidence of FHFs remained almost unchanged during the periods analysed. The population examined were superimposable in terms of demographics, comorbidities, type of fracture, peri-operative complications, percentage of operations performed within 48 hours from hospitalization and 1-year outcome. Discussion Our results are in line with those already present in the Literature. Conclusions Our study revealed a significant impact of the restrictive anti-contagion measures on the overall orthopedic surgical volume, but, at the same time, we could affirm that the pandemic did not affect the management of FHFs in non-COVID patients, and their results.

Functional Outcomes of Anterior-Based Muscle Sparing Approach Compared to Direct Lateral Approach for Total HIP Arthroplasty Following Acute Femoral Neck Fractures

“…In our opinion, the statistical significance of both earlier hospital discharge and 3 months TUG test can play a critical role for this specific population of elderly patients with FNFs. As already extensively reported in the literature, [33][34][35][36] patients have a very high early mortality rate independent from clinical scores (HHS and OHS, in particular), therefore an early hospital discharge and a faster TUG test recovery could potentially be better indicators of the clinical status of the patients more than clinical scores by themselves. However, critical benefits for such a population of elderly patients with FNFs did not last more than 3 months after surgery, meaning that neither the OHS nor HHS differences reached a significant minimal clinically important difference.…”

Impact of COVID-19 Pandemic on Fragility Fractures of the Hip: An Interrupted Time-Series Analysis of the Lockdown Periods in Western Greece and Review of the Literature

“…A decrease in the incidence of fragility fractures of the hip was reported in studies from many European countries [ 19 , 31 , 33 , 39 , 40 , 42 ], which mainly refer to periods corresponding to the first lockdown period in Greece. Similar results were noted by a multicenter study in Brazil which evaluated an extended period of social isolation [ 41 ], in a country with high compliance to the quarantine measures, in accordance with the situation in Greece during the first lockdown period.…”

“…In this respect, the increased incidence of hip fractures could be attributed to immobility resulting from COVID-19 lockdown measures, which, however, seems not to immediately affect the population of our study, even if the rate of decrease in the number of hip fractures in GHP seems to have slowed down during the second lockdown period. Overall, analysis of the literature reveals that the impact of COVID-19 social-distancing policies on the incidence of hip fractures can vary significantly, even within the same country or region, where a similar level of compliance can be assumed, taking into account the differences in demographics and the spread of the infection [ 42 ]. Furthermore, it appears that these effects may vary depending on the period of time studied, highlighting the complex interplay between public health measures and their impact on fracture rates.…”

“…Although these findings did not reach statistical significance, they suggest a trend toward improved patient management during times of restricted hospital productivity. In regard to time to surgery, mixed results have been published in the literature with several authors reporting lower or comparable delays compared to the control groups from previous years [ 32 , 33 , 36 , 40 , 42 , 47 , 48 ], while others found an increase in time to surgery by up to 2.4 days by mean values [ 34 , 35 , 39 , 49 ] ( Table 5 ).…”